Wednesday, October 16, 2019

THE BRAIN IMAGING REVOLUTION: Driving Tech Upgrades to Support Diagnosing Mental Illness


NEW ADVANTAGES FOR NEUROLOGICAL AND MENTAL HEALTH PREDICTIONS
October, 2019/NYC - Dr. Robert Bard, Cancer Diagnostic Imaging specialist is currently involved with several research teams investigating the benefits of Neuro-Imaging technologies to study PTSD and other mental disorders.  He is also underway a major collaborative performance study of various scanning innovations including the Transcranial Doppler Ultrasound with top engineers of  international manufacturers toward advanced brain imaging.

Recent news of imaging technologies targeting depression or suicidal risks have captured the attention of clinical researchers and medical centers nationwide. Inspired in part by the rise in PTSD and suicide reports from military, law enforcement and emergency personnel comes a rise in major public interest to develop more efficient studies to aid in identifying (and predicting) self-destructive disorders. Validating the many clinical benefits of neuro-imaging is part of Dr. Bard’s 40+ year academic commitment as an advocate of non-invasive diagnostic protocols. In the cancer scanning environment alone, he has been a staunch supporter of the pioneers of ‘safer’ (non-surgical) technologies including Focused Ultrasound and the progression of the 4D Doppler, which have mostly come from European designers and foreign clinical trials.


TECHNOLOGY LEVERAGES ABILITY TO READ PATIENTS
The pilot research to scan PTSD was formed in part by the FIRST RESPONDERS WELLNESS RESOURCE GROUP- an advocacy project supported by Dr. Bard for cancer prevention, wellness education and occupational hazard screening.  Recent meetings with retired FDNY fraternal organizations such as the RMA and the Columbia Association raised concerns from latent Cancers to PTSD and depression.  According to mental health expert Jessica Glynn, LCSW, “a first responder who experiences or witnesses a traumatic event can develop physical and emotional symptoms as a result. These symptoms can manifest in anxiety, depression and/or auditory and visual hallucination related to the event (flashbacks). All of these can lead to severe destress and impaired functioning in their personal and professional lives. Unfortunately, a large percentage of these symptoms often go unchecked and untreated because most sufferers instinctively conceal them”

On a recent meeting with the NYS Troopers Police Benevolent Association, Director Michael Brooks was given a private tour of Dr. Bard’s neuro-cranial technology during a private demo of a brain scan pilot project. Mr. Brooks expressed the need for advanced research in diagnostics and health treatment in our community of public service personnel- including mental health. "This is a very exciting time in medicine where advanced technology is tuned to battling more and more complex disorders… It would be great to see more independent groups like Dr. Bard's program share ground-breaking solutions like this with all service communities." (see News feature @ First Responders Health Resource Magazine)

The white paper study by the Ruderman White Paper on Mental Health and Suicide of First Responders examines a number of factors contributing to mental health issues among first responders and what leads to their elevated rate of suicide. One study found that on average, police officers witness 188 ‘critical incidents’ during their careers. This exposure to trauma can lead to several forms of mental illness. For example, PTSD and depression rates among firefighters and police officers have been found to be as much as 5 times higher than the rates within the civilian population, which causes these first responders to commit suicide at a considerably higher rate. These numbers reflect the recent news reports of job-related depression and a recent spike in suicide rates in emergency responders and law enforcement.  Additional data from the NATIONAL INSTITUTE OF MENTAL HEALTH and the Centers for Disease Control and Prevention (CDC) 2017 Reports indicated that suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people.

“What was once science fiction is now a reality in so many areas of medical technology”, starts Dr. Bard. “Throughout my career, I have had the pleasure to witness the dramatic evolution of both scanning and treatment solutions – like the sciences of AI, robotics, laser and ultrasound… but the real benefit to the patient is the entire medical community (finally) beginning to work together to collaborate on problem solving and coming up with more efficient programs.”

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PRESS RELEASE
Media Contact: Carmen R. DeWitt / Elane Alsten of the rightwriters.com- 631-920-5757 - nycralliance@gmail.com

REFERENCES & SPECIAL THANKS
The AngioFoundation/Cranial Scan Program: http://cranialscan.com/
The Ruderman Family Foundation: https://rudermanfoundation.org
The National Institute for Mental Health: https://www.nimh.nih.gov/index.shtml
The Centers for Disease Control and Prevention: https://www.cdc.gov/

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CRANIALSCAN FEATURE NEWS EXTRA:

SUICIDE COULD BE PREDICTED WITH BRAIN IMAGING
Published 30 October 2017| By Honor Whiteman | Full article source: Medical News Today

What if it was possible to predict which people are at high risk of suicide? Researchers may have brought us a step closer to such a feat, after developing a brain imaging technique that could pinpoint individuals with suicidal tendencies.an upset girl with her head in her hands Researchers say that their new algorithm could identify individuals who are at high risk of suicide. Suicide is the 10th leading cause of death in the United States. Each year, around 44,193 U.S. people take their own lives — which is the equivalent to around 121 suicides every single day. (Go to medicalnewstoday.com (link) for complete article)

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By Emily Underwood | Aug. 20, 2019 - Source: ScienceMag.org -AAAS

Scientists have already found several brain features that align with suicide risk. The best studied comes from neuroscientist John Mann of Columbia University. In the early 1980s, he examined the brains of people who had died by suicide, donated by their families. The organs had markedly lower levels of the neurotransmitter serotonin than those of depressed people who had died in other ways. A June study in the Proceedings of the National Academy of Sciences… focused on post-traumatic stress disorder (PTSD), which can also raise the risk of suicide.  (See complete article:link)



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For more articles, visit: http://cranialscan.com/

DISCLAIMER
MODERN DIAGNOSTIC SCIENCE (TM) is the official blogsite of Bard Cancer Diagnostic Imaging.  Its content, its interviews, images or content from this article/website is not endorsed, sponsored or associated in any way by any of the participants mentioned in this page. Any reference of any city, state or federal entities are strictly for information.  MODERN DIAGNOSTIC SCIENCE (TM) is an independent website supported and partially sponsored by The Biofoundation for Angiogenesis Research and Development (www.AngioFoundation.org) a 501c3, the executive board of Awareness for a Cure, the NY Cancer Resource Alliance (Linkedin group), The Male Breast Cancer Coalition (501c3) and its respective donors and is produced by donation by IntermediaWorx Educational Publishing (imworx.com). This website/blog/web publication is intended to provide users with free online access about the contents included in this site. The website represents the informational works of an alliance of volunteer awareness speakers, writers, educators, cancer survivors, retired rescue professionals and clinical professionals whose contribution to this website and its public advocacy programs are to provide available public information and resources about any health disorders in our community, civil service workers, rescue workers or any person(s) exposed to toxins during their work.  All person(s), participants, writers, speakers, video presentors and all those who are mentioned in this website offer their insights, research reports, editorial content, technical material and/or personal ideas have done so freely and independently of each other are are published under COLLECTIVE COMMONS as informational and free public awareness.The information contained in this website should not be construed as medical advice on any subject matter.

Monday, September 23, 2019

Avoid the risks of unnecessary BIOPSIES

By: Dr. Robert L. Bard
Edited by: Darleen Garza, CSW

When it comes to finding abnormalities in a patient's exam, many conventional-minded doctors tend to tread on the side of caution... but usually at YOUR expense! Finding an unusual spot that appears questionable often warrants the automatic response- "cut it out and send it to the lab for a BIOPSY". As with all invasive surgical procedures (however large or small) conducting a biopsy may carry risks such as bleeding, infections, post-surgical scars and potential damage to nearby tissues and organs -- and others can also fall into further complications.

The year is 2019- the era of the non-invasive tech movement!  For over 20 years, biotech developers have invested tremendous resources into subdermal imaging where identifying what's under the skin is (now) most often the first course of action over cutting into it. The age of robotics, artificial intelligence (AI), highly developed laser applications and advanced sonic diagnostic protocols are all fast replacing the age-old scalpel as part of risk reduction, time/cost advantages and increased performance in the world of clinical diagnostics and medical treatment.

Imaging technologies like the 3D & 4D Power Doppler Ultrasound™ is recognized in many countries to accurately and successfully scan, study and fully diagnose cancer tumors in all stages of malignancy. More radiologists and clinicians stand on the side of innovation as they confidently rely on the most current devices to deliver the most accurate readings while bringing significant reduction to patient stress under a scan- many of them perform successfully within mere minutes!


BIOPSY Defined + Cancer Risks
The first biopsy was performed in 1875 by M. M. Rudnev. [1]  According to the national Cancer Institute, A BIOPSY is defined as the removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures.

There are 3 types of biopsies:  (1) INCISIONAL biopsy, in which only a sample of tissue is removed surgically; (2) EXCISIONAL biopsy, also surgical- where an entire lump or suspicious area is removed; and (3) NEEDLE biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Removal of living tissue surgically or through aspiration of cells from the tumor (w/ needle) carry the risk of seeding tumor cells either into the interstitial tissue fluid from where they are carried to lymph nodes, or into the veins draining the tissue from where they enter the vasculature and may travel to lodge into any organ or tissue. There is also a risk of dragging cells along the surgical incision or needle track leading to the possibility of increasing the spread of cancer through biopsy.[2]



Bye-bye Biopsies?
Advances in Medical Imaging (Source: NIH)


Nearly 200,000 Americans are hospitalized each year for chronic liver disease. Typically, a biopsy is used to diagnose and evaluate the liver for signs of stiffening, or fibrosis. For a biopsy, the doctor uses a needle to take a tiny sample of liver tissue and then examines it under the microscope for scarring or other signs of disease.

As an alternative to liver biopsies, NIH-funded investigators led by Richard Ehman at the Mayo Clinic have developed Magnetic Resonance (MR) elastography, a noninvasive MRI approach that can measure the amount of stiffness in a very small amount of tissue. The noninvasive detection of fibrosis by MR elastography offers patients multiple advantages over biopsy examination, including less discomfort, a much lower risk of complications, and a decrease in expense.

Two liver ELASTOGRAMS
Elastograms of patient with normal liver (left) and patient with diseased liver (right). Red and yellow mark hardened tissue in the liver (area inside dotted lines).Mayo Clinic
According to Dr. Ehman, MR elastography has already made a substantial difference in patient care. One example is a patient with hemophilia who previously contracted hepatitis C from a blood transfusion. Liver biopsy was contraindicated because of the hemophilia, but MR elastography was used to determine if there was fibrosis associated with the hepatitis. In this case, the results showed fibrosis and the individual was started on antiviral therapy.

Early results show this same technique might also be used to improve the detection of breast cancer and help distinguish a benign mass, such as fibrocystic disease, from cancer.
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IMAGE-GUIDED NEEDLE BIOPSIES BRINGS INCREASED LEVEL OF SAFETY AND DIAGNOSTIC ACCURACY

Through the use of advanced 3D Doppler Ultrasound technology, we can eliminate the need for surgical procedures when diagnosing a tumor and taking the guesswork out of targeting the proper area for a fine needle biopsy.































Fig A: indicates a large irregular mass (yellow circle) but only one quarter of it (red / 27% Vessel Density) is filled with cancerous active tumor vessels.  This is the site where you want to insert a biopsy needle for best diagnostic results of cancer cells. The rest of the area outside the red circle is filled with debris or dead tumor or necrotic debris- bringing confusing results because there's no active cancer.

Fig. B:  This view is from another angle of a 3D Histogram Scan.  Inserting the needle into the 1% (undesired- red circle) area gives you mostly dead tissue or degenerating inactive cancer tissue.Whereas the orange flame-like area outside the red circle and inside the yellow clearly indicates a high volume of tumor vessels.

Fig. C: The photo shows the palpable axillary lymph node measures approx. 2.5". Without image guidance, one might target the needle in the bottom of the bulging mass (near the red scar)- and as per Fig A and B, you're going to get no cells or fluid, only dead cells.

Fig. D:  Doppler Ultrasound technology provides accurate reading - showing quantitative measurement of the tumor vessels. This gives a benchmark or a baseline, with which to measure treatment.  As an example, if the Vascularization Index reads 20 or 10%, treatment is a working option- whereas a reading of 30 or 40% indicates treatment would fail. This is a guideline.


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Cancer Screening from Simple Blood Test: Introducing the "LIQUID BIOPSY"
(Source: PR Newswire LAM)

On May 15, 2019, Laboratory for Advanced Medicine (LAM), a commercial-stage medical technology company focused on developing innovative technologies for the early diagnosis of cancers, announced positive results from a new study that evaluated DNA methylation-based marker panel for early diagnosis of nasopharyngeal carcinoma (NPC).

The results of the study show an overall sensitivity of 97% and a combined specificity of 100%, demonstrating the high analytical potential of the IvyGene Test. The study was conducted using samples obtained from 168 subjects, including 59 subjects diagnosed with NPC (Stage I to IV), 14 subjects diagnosed with benign nasopharyngeal disease and 43 healthy subjects. From the 59 subjects diagnosed with NPC, a total of 57 subjects were correctly identified (sensitivity of 97%), with little difference between the sensitivity of detecting Stage I to Stage IV NPC (range 92% to 100%). Additionally, for subjects diagnosed with other cancers, a total of 86% of subjects were correctly identified as negative for NPC. Finally, all 43 samples drawn from healthy donors and all 14 samples drawn from subjects diagnosed with benign nasopharyngeal disease were correctly identified as negative for NPC (combined specificity of 100%).

See complete article



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.  


THE POWER OF LIGHT 
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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RCM TECHNOLOGY DEVELOPMENT
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.”

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TECHNICAL CONTRIBUTORS

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


PUBLISHER

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- www.CancerScan.com) 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.


ASTHMA: A MAJOR PREVALENCE WITH FIRST 9/11 RESPONDERS

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).

"THE TELLTALE COUGH"- EXPLAINED
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.



DIAGNOSTIC OPTIONS
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.



EXTRA: ASTHMA TREATMENT OPTIONS  
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.

Medications
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:

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STAFF EDITOR / CO-PUBLISHER

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.

CONTRIBUTING 9/11 PHOTOGRAPHER

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,  https://www.kevincoughlinphotography.com/

PROFESSIONAL INTERVIEWED IN THIS ARTICLE
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



References:
1)The 9/11 Attacks are Still Going On with Asbestos Based Cancers- by: Jesse Stoffhttps://patch.com/new-york/huntington/9-11-attacks-are-still-going-asbestos-based-cancers


Monday, January 21, 2019

CANCER IMAGING INNOVATION ADVANCES AT LIGHT SPEED

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.


TEST-DRIVING THE LATEST IMAGING INNOVATIONS
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

NY MALE BREAST CANCER JOINT TASK FORCE: AWARENESS & SCREENING

FOR IMMEDIATE RELEASE

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."


AWARENESS TO ADDRESS THE RISING NUMBERS
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)."


NY COMMUNITY OUTREACH TO BATTLE MALE BREAST CANCER
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

MALE BREAST CANCER CHECKUPS- THE NEXT NORMAL!



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.

CURING THE STIGMA
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.

For more information, visit: www.MBCSCAN.com

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Sponsored in part by:



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.

TEXTURES
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.

TYPES OF FLUIDS AROUND THE IMPLANT
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.  

THE DIFFERENCE BETWEEN BENIGN SCAR TISSUE AND BIA-ALCL
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. 

ASPIRATION VS BIOPSY
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: www.cancerscan.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.  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.


ADDITIONAL ARTICLES & REFERENCES:
Cancer Alert: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

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



LEGAL DISCLAIMER

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