Thursday, August 30, 2018

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

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

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

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

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

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

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

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

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

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

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

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