Monday, July 13, 2020


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A survey of recent med-school graduates (of 2020), recently certified Emergency Responders and front-line recruits from New York nursing programs stamps a distinctly future-bound vision for diagnostic methodologies and treatment protocols.  "This is a generation that did not experience life without the internet or the smart phone", and whose views of patient care is most often fast-tracked by current innovations and sustainable alternatives that boldly paved the road to our "new normal".

Such is the case of the PORTABLE ULTRASOUND IMAGING DEVICE - aka the "modern stethoscope".  Powered by calibrated sound frequencies, this non-invasive scanning solution safely diagnoses the physiological condition of most vital organs and tumors in real time.  Since the first clinical use of the echocardiogram in the 1953, to the introduction of the ultrasound in 1966 to OB/GYN medicine, to the success of the Doppler ultrasound's blood flow imaging in the 1970s, significant advancements in ultrasound technology continue to challenge earlier forms of imaging modalities like its radiation-based counterparts (like the isotope scan, X-rays and CT Scans).  But much more than the ultrasound's safety benefits and performance upgrades is its ability to evolve into a portable hand-held "diagnostic lab on-the-go".  This makes it the ideal imaging base for the many remote demands and for the new generation of health responders.

Pathology is the analytical study of diseases aligned with identifying conclusive medical definitions.  Diagnostic science is based on the thorough and systematic study of a patient that includes: physical examination, physical inspection and lab testing (of blood, fluids or skin samples).  Patients may intuitively seek a second opinion if there may be distrust or uncertainty in the initial diagnosis. Modern medicine offers the use of diagnostic imaging to relieve any doubt about the patient's condition from prior determination.  Where inconclusive lab testing or other patient studies may fail or conflict in some way, imaging (along with a trained imaging reader) most often resolves this doubt by virtue of presenting visual proof, hence the term "seeing is believing".  Imaging supports conclusive assessment as the 'ULTIMATE VALIDATOR'.

Members of Gen-Z are more diverse than any previous generation, and they are recognized to be "on track to be the most well-educated generation yet". They are also digital natives who have little or no memory of the world as it existed before smartphones.  This concludes that they are expectant of high speed info access and instant screen-based answers available from any physical location.  For this generation, portable devices such as the hand-held ultrasound (with its many applications) aligns with their era of work ethics.

The Gen-Z culture is also the newest professional member of the Covid era, where the global pandemic forced a redesign in patient care protocols, dictating major safety guidelines and heavy dependency to remote technologies.  Safety-based conveniences (such as teleradiology) are  widely-replacing in-person visits and the potentially risk-filled waiting rooms.  A surge of mobile testing labs and a rise in the use of portable diagnostic ultrasound scanners are the latest growing alternatives to doctor visits and physical check ups.

Blair Blakely, spokesperson for Burtterfly Network provided this statement about the current industry; "Bedside imaging that is accessible to front line clinicians has been limited traditionally by cost, and technical difficulty. As technology moves forward, and innovation typically applied to consumer devices turns to medical applications, barriers to access are much reduced. That, combined with Gen-Z tech-savvy, has improved access to diagnostic ultrasound for point of care applications, which ranges from arbitrary yes/no answers to questions such as internal bleeding - or not, to the sophisticated assessment of dyspnea."

1960, Douglas Engelbart, a pioneer in computer engineering introduced the groundbreaking principle of SCALING. Five years later, Gordon Moore (the founder of Intel Corp.) applied this to the invention of the microchip and the mind set behind what would be the future of all technology called Moore's Law, a.k.a. the "faster, smaller, cheaper" rule of economics.

The battery-powered, pocket-sized ultrasound machine became commercially available in the late 1990s where smaller and lighter devices with higher image quality such as those manufactured by GE Healthcare, Siemens and Philips dominated this portable market. These pocket-sized ultrasound machines allowed clinicians to have immediate visual correlation with physical examination findings. They also allow for quick and instant assessments, which are extremely important for emergency physicians. At a healthcare resource allocation level, they significantly reduce a patient’s waiting time and improve clinician’s workflow. Furthermore, the cost of pocket-sized ultrasound machines is much lower than that of standard ones. [3]

Disaster and mass casualty incidents (MCIs) are defined as occurrences wherein the scale and volume of injuries exceeds the ability of medical response at multiple levels. Coordinated responses to MCIs place a strain on the capacity of first responders in the field, medical personnel, and health care resources. The sudden increase in the number of patients and the possibility that many of them are critically injured create a need for screening and diagnosis rapid enough to compensate for the extreme patient load. Moreover, as a result of the disaster, many people seek off site medical care for both acute and routine conditions unrelated to traumatic illness. Hence, ultrasound performed by first responders and clinicians is in many ways ideally suited for disaster situations because it is a rapid, portable diagnostic tool with a variety of applications.[4]

Ultrasound technology continues to rapidly evolve to become smaller, more affordable, and more user-friendly. A new category of smaller handheld devices has recently emerged whose main advantages include increased portability and affordability. The incorporation of such a device into the initial physical examination could potentially lead to faster diagnosis and treatment. Early applications of portable ultrasound have been in the field of echocardiography and battlefield trauma, and some concern exists about whether image quality is being unsafely compromised to achieve greater portability [5].

By: Dr. Noelle Cutter
A year ago I would agree that the generation of cancer medicine is divided....where researchers around the globe were working in silos to find cures, instead of in collaboration.  That has changed rapidly in this current pandemic.  Science has been forced to work together and at rapid speed for the good of not only their community, but the entire world.  Research leads to cures. At the heart of cancer research lies our new generation of academic, Gen Z.  Their social media, technology savvy selves are more connected now then ever before.  And it is these connections that are needed to solve the inadequacy that has plagued the last few decades of cancer treatment.

In medicine we need to expand collaboration between institutes across the globe, fostering lasting networks and partnerships for change.  Academia, industry needs to come together in the fight against cancer.  We cannot be siloed in competition, but rather united in this battle.  GenZ students have transformation at the heart of their work and mindset, and they will re-imagine the world in which we live to make it better for our future generations. GenZ has given us hope…they have shown the world that hat working together we can be a humanity against cancer.

According to the AIUM (American Institute of Ultrasound Medicine), today's ultrasound outperforms XRAY, CT and MRI devices in many localized and remote trauma imaging needs.  The ultrasound scanning device is the popular choice when it comes to zero radiation, fast responding, minimal manipulation, real-time data gathering, recognition of burn depth, spotting ligament tears, nerve entrapment and infections.  Adding the element of portability makes it highly accessible, fast responsive and a true game-changer in the fields of rescue and general patient care.

The AngioFoundation, the NY Cancer Resource Alliance and Health Service Innovations partnered with Dr. Robert Bard (internationally published authority in advanced ultrasound education) to invest in a global advocacy movement supporting the new standardization of ultrasound use in all remote emergent cases. "At this day and age, with some of the top features offered by most portable ultrasound models, it's time every first response unit and remote facility invested in this type of equipment," started Dr. Bard. "From Paramedic Services to Emergency Rooms, Coast Guard to Commercial Airlines... there is no excuse left why agencies resist having an ultrasound on the field.  It is a critical step backward in this age of technology where being ill-equipped in a rescue situation puts lives at higher risk!"

EMT's all across the country concurs with Dr. Bard's crusade to arm emergency responders with the portable ultrasound. Elizabeth Banchitta, a Long Island ambulance technician states, "The idea of a portable pre-hospital ultrasound is so affordable and sensible... it can easily identify traumas and is something that the military and helivacs are now equipped with.  Using that travel time to see what's going on so much earlier and work with an MD in real time is a powerful addition to emergency response."


Dr. Noelle Cutter 
is an associate professor and director of the First Year Experience at Molloy College.  By training, she is a scientist in the field of molecular biology where she has dedicated her career to studying alternative treatment options for pediatric patients diagnosed with a rare and aggressive form of brain cancer known as Medulloblastoma.  Dr. Cutter takes a unique and passionate approach to working with patients.  Cancer remains the most common cause of death due to disease in children. Over the last decade, researchers have made great strides in understanding cancer but finding cures has still been difficult. In an ever changing world sometimes a new approach to solving this problem is necessary. GenZ is transforming the viewpoint in society by setting a local example through their teamwork approach in solving problems. And it is this collaboration which will be needed to solve some of the world’s larger crisis, like cancer. Dr. Noelle Cutter is most interested in the role that methylation plays in gene regulation allowing tumors to grow and divide. By doing so, she hopes to be able to better diagnose patients so they can be treated more efficiently. 

Dr. Robert L. Bard
currently runs a private imaging center in NYC specializing in advanced 3-D sonography to detect cancer tumors and other health disorders.  He lectures in medical conferences worldwide, runs a cancer awareness program for first responders and is also a publisher of countless educational books and articles about cancer imaging and other health/wellness related materials. Dr. Bard maintains an active role in supporting the medical community by contributing relevant articles to major health magazines, medical journals and news organizations pertaining to current health concerns. His recent projects include advocating and inserting TELEMEDICINE in the medical community as a safe alternative for patients.  Other projects include an upcoming collaborative textbook series on Covid-19 with a list of top experts in the field.  Dr. Bard is also the president of the AngioFoundation (501c3), as philanthropic organization dedicated to funding and supporting public education about current treatment protocols worldwide. 

SPECIAL THANKS to Dr. Noelle CutterDr. Robert Bard, Elizabeth Banchitta (EMT) and "Cousin Sal" Banchitta (ret. FDNY), AIUM/American Institute of Ultrasound MedicineDr. Philippe Kory (MATH+), Dr. Stephen Chagares and The Butterfly Network for their informative support and contribution, without whose help this article could not have been possible.

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My meeting with Dr. Yvette Groszman (part 1)

 FOR INTERNAL USE ONLY- DO NOT SHARE OR PUBLISH Topics discussed in this video for transcript: IMAGING & ULTRASOUND USE in OBGYN Yvette ...