SPOTLIGHT: DR. MENA RAMOS & THE GLOBAL ULTRASOUND INSTITUTE

During the 2024 UltraCon (AIUM) Imaging Symposium in Austin TX, HealthTech Reporter connected with DR. MENA RAMOS, co-founder and co-CEO of Global Ultrasound Institute (GUSI).  Highly credentialed in the field of clinical imaging, Dr. Ramos is also a family physician, an entrepreneur, health & medtech consultant specializing in healthcare innovations and is a strong advocate for Point-of-Care Ultrasound (POCUS) adoption across the continuum of care with a particular emphasis in primary care and global health.   

Meeting Dr. Ramos is a most inspirational experience as one of the most supportive advocates of the ultrasound movement.  She is both a visionary for the future of imaging and a highly spirited crusader for global access to ultrasound where every healthcare practitioner is empowered to offer a rapid, reliable, accurate ultrasound-enabled diagnosis directly at the point-of-care for any patient, anywhere.  Her mission through the Global Ultrasound Institute is to revolutionize healthcare by offering a comprehensive POCUS solution for health systems worldwide through education, training, pathways to credentialing and certification, AI, software, and expert consultation. GUSI plays a pivotal role in groundbreaking initiatives funded by the Gates foundation to improve maternal and fetal health in Kenya and South Africa and offers thousands of POCUS scholarships accessible in over 60 countries worldwide.  

In a recent meeting with Dr. Robert Bard (the sr. diagnostic science director of the AngioInstitute), Dr. Ramos shared her tireless educational work and her passion to bring imaging to all shores. They collaborated and explored concepts in tele-health, remote overreading, cancer screening and other expansive ideas for prospective partnerships.  Where Dr. Bard has helped lead the diagnostic imaging movement in areas like breast cancer, prostate and skin from an in-office paradigm, Dr. Ramos' prowess to expand the access of clinical screening through point of care from the field makes the two crusaders offer a powerful potential for collaboration. "I am vastly impressed with Dr. Ramos' talents as a communicator to the world... and her company's unique programs to bring clinical ultrasound to areas without access. She is a true change-maker and (I'm sure) the POCUS brands and remote communities owe her a debt of gratitude for her work internationally", says Dr. Bard. 

SPOTLIGHT: DR. XIMENA WORTSMAN - A VISIONARY IN DERMATOLOGIC ULTRASOUND

FOREWORD: By Dr. Robert L. Bard

Decades into its expanding medical applications, ultrasound continues to find its way to fulfilling more screening and diagnostic areas- earning the respect it (now) deserves from the vast majority of the medical community.  This technological advancement is greatly due to the global collaboration between developers and the clinical leaders who drive its diagnostic applications through field research. Joining the best and the brightest in conferences such as the AIUM’s UltraCon2024 event (in Austin, TX) honored individuals who advance the field of medical imaging and ultrasound and improve patient outcomes across the globe. 

To be part of an international and multidisciplinary society where we can witness true visionaries and pioneers lay the groundwork for the future of our science.  It is a joy to meet and collaborate with clinical leaders and educators like Dr. Ximena Wortsman - a direct inspiration to my own commitment to exploring the many facets of ultrasound technology for both patient care and clinical research. Her campaign to make the concept of “dermatologic ultrasound” a globalized paradigm and a movement is nothing short of leadership at its finest.  Dr. Wortsman’s textbooks, articles and lectures speak volumes for the future of integrative diagnostic medicine, forging a refreshingly modern view of dermatologic analysis, light years beyond convention.  Her generous work directly supports the continuing education and the advancement of technical innovation in diagnostic and therapeutic medicine. It is for this reason that HealthTech Reporter recognizes the remarkable work of Dr. Ximena  Wortsman.  Her recent lectures at the 2024 UltraCon event highlighting her clinical expertise in ultrasound diagnostic imaging in dermatology are priceless resources for the medical community at large.  

ABOUT DR. WORTSMAN

Dr. Ximena Wortsman is a radiologist from Santiago, Chile-  subspecialized in dermatologic ultrasound and a fellow member of the American Institute of Ultrasound in Medicine (AIUM). She received the Joseph H Holmes Clinical Ultrasound Pioneer Award 2024 of AIUM.  During the last 23 years, she has been fully dedicated to developing applications and research in dermatologic ultrasound. She has more than 200 publications, including three books edited by Springer, which are “Textbook of Dermatologic Ultrasound,” “Atlas of Dermatologic Ultrasound” and “Dermatologic Ultrasound with Clinical and Histologic Correlations,” and multiple book chapters and papers in indexed peer-reviewed journals. Her current h-indexes are 44 in Google Scholar and 31 in Web of Science. She founded the dermatologic community at AIUM and is the medical director of the Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues in Santiago, Chile. Dr. Wortsman is an adjunct professor at the Department of Dermatology of Universidad de Chile and the Department of Dermatology of Pontificia Universidad Católica de Chile in Santiago de Chile. Her daily work and lines of research comprise a wide range of ultrasound applications in dermatology, including skin, nail, and hair pathologies. She has actively participated in the early detection and characterization of multiple dermatologic pathologies and in creating guidelines, protocols, and sonographic scorings in this field, which are currently used in multiple countries worldwide.  

Our editors met with Dr. Wortsman at the 2024 ULTRACON event in Austin, TX - an annual conference by the American Institute of Ultrasound in Medicine (AIUM).  She presented the following lectures on April 7 and 8:

• Ultrasound Imaging of the Nail

• Ultrasound of Common Benign & Malignant Ungual Lesions

• Ultrasound Imaging of Skin Tumors

• Ultrasound of Benign Cutaneous Tumors

• Ultrasound of Skin Cancer: What you need to know

• Complications in Aesthetics- Ultrasound imaging & Intervention

• Ultrasound Patterns of Cosmetic Fillers

• Dermatology Scientific & Case Report  (Sessions 1 &2)

INTERVIEW

I am Dr. Ximena Wortsman. I'm a radiologist (and) have worked in dermatologic ultrasound for over 20 years. I started my training in musculoskeletal ultrasound in Detroit (in Henry Ford Hospital) when the first machines with high-frequency probes were developed. 

I started looking at my nails and thought the images were great. From the library, I found only two articles published about ultrasound imaging of the nail; one was from Denmark, and the other was from Italy. I contacted the Danish authors and proceeded to build a project with the ultrasound company and installed the same model of ultrasound machine that was available in Detroit in a Danish Department of Dermatology. Therefore, I ended up in Copenhagen (Denmark), working in the Department of Dermatology of Bispebjerg and Roskilde Hospitals under the supervision of Prof. Gregor Jemec. 

Scanning dermatologic patients with this new technology, I realized the huge potential of ultrasound in dermatology, and I saw a lot of things that had not been published. I began to gather a relevant group of cases, and then I came back to my country while collaborating with the dermatologists, gathering more experience with more cases and publishing. Twenty years later, I am fully dedicated to dermatologic ultrasound. 

ADVANCING CONCEPTS IN ULTRASOUND IMAGING

Today, we are decreasing the number or eliminating multiple biopsies, because ultrasound can make diagnoses in several fields. We are working (for example) with benign cutaneous tumors that are very common in children. But now, they don't need to biopsy before the surgery; they can go from an ultrasound scan to surgery. 

Another example is skin cancer; we can scan a primary tumor, and we can tell information that the clinicians cannot deduct from the naked-eye examination about the depth of the tumor. This is important because they can't deduct that information from imaging techniques like MRI, CT, confocal microscopy, or OCT (optical coherence tomography).  

Confocal microscopy and OCT are used in some dermatology departments, but they don't have enough penetration to penetrate the tissues and tell you the real depth of a large tumor.  CT and MRI present a lower axial spatial resolution than high-frequency and ultra-high-frequency ultrasound.

With ultrasound, we can see skin tumors beyond the subcutaneous tissue, the muscular layer, or contact with the bone. We can provide the critical information in these cases. 

We're not talking even of the local, regional staging that we can already perform on ultrasound; we're talking about the primary tumor. That is important also because you can program your time spent on surgery based on ultrasound imaging. It's not the same when you're in surgery for a large tumor because you will spend more time than expected in the operating room.

We are also working on inflammatory diseases, and several of them have ultrasound diagnostic criteria, such as Hidradenitis Suppurativa (HS) or Morphea (localized cutaneous scleroderma). In those cases, ultrasound avoids biopsies because you don't need a biopsy to diagnose or monitor hidradenitis suppurativa or follow-up of the inflammatory activity in morphea. You can make a clinical diagnosis and then use an ultrasound to support it. 

We are also working on nails- and imaging of the nails is a critical field because it is challenging to perform nail biopsies because they can leave scars on the nails.  These scars are permanent because you can damage the matrix of the nail. So, it is essential to have imaging support to detect nail tumors,  but it is also possible to detect ungual inflammatory diseases and alterations of the location of the nail plate. 

Overall, dermatologic ultrasound is a vast field right now, and it is not only valuable for general dermatology. We also work with the aesthetic field and can diagnose complications of cosmetic fillers and potential risks during these procedures. 

INTERNATIONAL PARTNERSHIPS

I collaborate with different clinical groups from different parts of the world on several dermatologic conditions. For example, one group in Germany works with ultrasound of skin cancer, and another in Spain works in hidradenitis suppurativa, while other groups in Italy, Romania, The Netherlands, and Brazil work in a wide range of dermatologic ultrasound areas. They are a mix of dermatologists and radiologists and advance quite a lot in an organized way. 

Besides my association with the AIUM, we founded an international Society of Cutaneous Ultrasound (ISCUS; www.is-cus.org), and I'm on the executive board.  We are trying to organize the annual ISCUS conference (for) 2025 in Valencia and gather everyone interested in this field in the global community. 

There are several societies that are expanding the horizons of imaging techniques (which includes ultrasound).  In the American Academy of Dermatology (AAD), there is an imaging course that could hopefully be launched this year, and I was involved in the ultrasound training area. The European Academy of Dermatology always has some sessions about varying ultrasound topics. The same applies to other European ultrasound societies such as SEECO, a Spanish Society of Ultrasound. They are very active in dermatological ultrasound as well.

1) https://www.eventscribe.net/2023/UltraCon/fsPopup.asp?Mode=presInfo&PresentationID=1190425

2) https://www.researchgate.net/figure/Figure-Legends_fig1_256466982

3) https://www.researchgate.net/profile/Ximena-Wortsman/3

4) https://ximenawortsman.com/dr-wortsmans-cv/

---

DR. XIMENA WORTSMAN is a Fellow of AIUM (American Institute of Ultrasound in Medicine). Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues (IDIEP). Adjunct Professor at the Department of Dermatology, Faculty of Medicine, University of Chile and the Department of Dermatology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile. More information at: www.ximenawortsman.com; X ( ex- Twitter): @xworts; Instagram: @xworts 

2024 PAIN MANAGEMENT SOLUTIONS (Part 1): LASER MODULATION THERAPY

Dr. Bard presents "Microvascular Image Guided Treatment of Arthritis" at the 2024 UltraCon AIUM Expo in Austin TX.

WHAT IS PAIN?  It is a subjective experience with two complementary aspects: one is a localized sensation in a particular body part; the other is an unpleasant quality of varying severity commonly associated with behaviors directed at relieving or terminating the experience. (NIH)

Bard Diagnostics has recently partnered with HealthTech Reporter to offer a public test drive of the ASPEN LASER Near Infrared Laser therapy.  Join our test drive of this FDA approved innovation and explore its potential healing capacity alongside our many patients who have found significant transformative advantages.  What's more, you may qualify for our SCAN & TREAT program where Dr. Bard's imaging team can monitor your therapeutic response with before-and-after scans of your target injury.

Laser light holds its intensity until it is absorbed by a medium; in the case of laser therapy, the medium is the body. The photon energy of laser light can effectively penetrate the skin and underlying structures, which accelerates the body’s natural healing process. Laser therapy utilizes the wavelengths and frequencies of visible red and near infrared (NIR) light to treat a variety of conditions at their source within the body through safe, non-invasive, and painless procedures.

CASE STUDY #5: RHEUMATOID ARTHRITIS / FIBROMYALGIA - KNEE

PHYSICIAN’S REPORT: Inflammatory disease involves the skin, joints, tendons, arteries and many solid organ systems.

BASE LINE: Before the induction of PBMT, subject was scanned to capture current pathology. Ultrasound report indicated a thickening of the epidermis from 200-900 microns.

(R TEMP- DOPPLER BLOOD FLOW) Left patella tendon. The insertion of the quadriceps tendon onto the superior patella surface shows dark edema at the attachment and it shows white echogenic fibrosis two centimeters proximal

Top image of the temporal area to measure arterial and autonomic nervous system response to the energy input shows that the upper 1mm of the 2 mm dermis is dark (single arrow) and the inflamed area has measurable inflammatory vessels (double arrow)

(ELASTOGRAM) Bottom image of the patella and patellar tendon demonstrates widening of the mid tendon (arrow) and elastographic confirmation of early fibrosis in the orange (color scale in elastogram: blue=soft, red=hard) 

Early detection of inflammatory disease allows for prompt treatment to avoid disabling chronicity.  This is particularly important since many diseased areas of tendons (tendinopathy) are asymptomatic until a minor stress ruptures the structure requiring corrective surgery as is the case of non-professional athletes.

PATIENT INTERIVEW 1:  7/5 12:30pm (One time Scan & Treat)  "Well, the problem was pain. I do have rheumatoid arthritis and I do have something that's called fibromyalgia as well. Wow. So sometimes it's a little confusing as to what's doing what to do different areas. Perfect. I agreed to try this on your knee because I was complaining about it to him at that time. So I sat down and the treatment was not for a long-- the treatment itself lasted only (I think) several minutes. It wasn't a long process. At first, I wasn't sure about what the effect was going to be- but even an hour later I was feeling so much better. And basically the pain that I had was pretty much eliminated-- in five minutes! I find it truly remarkable. (Upon getting an ultrasound scan,) Dr. Bard was able to show me the area of inflammation. (From a pain measure scale of 1-10,) I started out somewhere around I would say six and after the laser, an hour later- it became a ONE. I drove home after the treatment and it's difficult to notice if I had the pain or not. It's really mostly when I'm standing. But by the time I got home, I was really able to walk up the steps and without any pain. Today (3 weeks after treatment) I'm kind of pretty much at ONE most of the time." 

THE SCIENCE & PHILOSOPHY BEHIND RED LASER THERAPY: Photobiomodulation is what we're actually doing when we look at red and near infrared light.  (it’s different from far infrared-that's a sauna creating deep heating in the tissue and sweating out toxins). Photobiomodulation is the application of red and near infrared light to tissue where there is disease or dysfunction.  The mechanism of action of light is very simple. It doesn't treat any specific disease or diagnosis, but it treats the underlying cause of all dysfunction in the body (all disease) and that is cellular health and wellness.

Within the cell, oxygen is supposed to flow into the mitochondria, which is the powerhouse of the cell, and that's supposed to produce adenosine triphosphate or ATP.  This is what every cell in the body uses for energy.  Due to exposure to via environmental toxins, lack of sleep, stress, injury and disease, lack of exercise, too much exercise, not enough sunlight, poor nutrition etc. oxygen flows in the cell and then it's bound by nitric oxide. That binding of nitric oxide with oxygen forms a deadly particle called a free radical.  This causes two problems: #1- that oxygen is now not free to go into the mitochondria- so our ATP production in the body drops.  #2- there's the abundance of free radicals is the root of every disease. It's the gene expression for things like cancer, heart disease and diabetes.  So what light does very simply is when we shine light in and we can get light into the cell at the right wavelength, dosage and power density, it simply unbinds the oxygen particle and the nitric oxide particle and the free radical is dissipated into the blood vessel walls. So now we have removed free radicals and inflammation inside the cell. Also, the oxygen respiratory chain starts up again and that oxygen particle is allowed to flow into the mitochondria, and the ATP now goes through the roof and rises again the body. So now you have a perfectly operating cell, which then does its job of treating disease, treating tissue repair, treating dysfunction in the body, 

Take advantage of our Clinical Review of the latest in non-invasive therapeutic technology. This is your opportunity to learn firsthand about the science of cellular regeneration and Photobiomodulation (PBM). Until April 22, 2024, qualified patients of Dr. Bard may receive Aspen Laser treatments FREE OF CHARGE as part of our clinical review.  For more information on this clinical performance study, call: 212.355.7017

---

HOW TO HANDLE ON-THE-JOB INJURIES AND MINIMIZE HEALTH RISKS   

Work related injuries take a toll on the employees as well as the company. With reduced productivity and health insurance payments, the company can suffer heavy financial setbacks. This is why most companies have realized the importance of increasing awareness when it comes to the workplace. Injuries at the workplace are more common than ever. Although manual handling is the most common cause of workplace injuries, sedentary jobs may also put employees at risk of Repetitive strain injuries (RSIs) and lung issues.

AWARENESS: When it comes to sedentary jobs, posture and height may be doing most of the damage. Educate employees of the best posture and height of their chair in order to minimize the strain and reduce chances of an injury (Cornelio, 2010).

POLICY CREATION: The very first thing that employers need to do is create a health and safety policy. This policy should be included and presented to employees along with all other contracts and policies in the workplace. This will let your employees know that safety and health are a primary objective.

HEALTH & SAFETY PROGRAM: The health and safety of employees is the responsibility of the employer. A health and safety program is mandatory for any company employing more than 20 individuals (CDC, n.d.)

CONTROL HAZARDS: Many hazards may be unavoidable depending on the nature of work and the product being created. Some occupations entail more risks than others. If an employee is putting themselves at risk, then it is the employer’s responsibility to identify all hazards and minimize the risks.

*** SEE COMPLETE ARTICLE ***

---

REVIEW: MUSCLE STRAINS CAN CAUSE PERMANENT PHYSICAL DAMAGE

By: Dr. Robert L. Bard

Muscle pain is something that is easy to overlook. Since it’s usually a mild dull pain and does not hinder daily activities unless at an extreme stage, people tend to wait too long before consulting a physician. There may be two kinds of a muscle injury.  You many have a sprain (which is the stretching or tearing of the muscle and the tendon) or a strain (which is the stretching or tearing of the ligament). Also known as Rhabdomyolysis, muscle injury is caused by a breakdown of the fibers in the muscle. This breakdown triggers the release of myoglobin into the blood which can even cause kidney damage.  A muscular strain can be identified by other common household names such as a spasm, cramp or a pulled muscle. These pains are usually associated with the neck, shoulders, and even pain in the lower back.

CAUSES OF MUSCLE STRAIN: Muscle strain may be caused by over stretching of the muscle which cause the muscle to tear or cramp. This over stretching can occur as a result of physical exertion. Over exertion may even lead to permanent muscle damage and may even be triggered by daily activities. This may lead to limited and painful movement (Holmes, 2011).

FIRST DEGREE strains such as those caused by a crick in your neck do not usually result in permanent muscle damage. SECOND & THIRD DEGREE strains, however, may be caused by high pressure activities such as: Running, Reaching with the arms, Climbing, Turning the head, Turning the neck & Twisting the back

*** SEE COMPLETE ARTICLE ***

ROBERT L. BARD, MD  (Diagnostic Imaging 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. His most recent program is dedicated to the reporting of mental health diagnostic and innovative solutions including the use of modern neuromagnetic technologies and protocols in his MEDTECH REVIEWS program. 

ULTRASOUND DIAGNOSTICS OF ENDOMETRIOMA

 

ENDOMETRIOSIS REVIEW 2023: FROM ESSENTIALS TO ADVANCEMENTS- By Dr. Robert L. Bard

According to the World Health Organization, Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.  It is a chronic disorder that can result in life-disrupting pain during menstrual periods, sexual activity and urination.  Currently, there remains no known cure for endometriosis, whereby treatment is usually aimed at managing its known symptoms.  One objective of the medical community is to conduct early diagnosis and research continues to pursue effective treatments.

Endometriosis starts in the endometrium with abnormal cellular proliferation.  Through the use of 3D Ultrasound, this disorder can be measured through the monitoring of the widening or the increased tissue in the endometrium.  Another form of quantitative measure is by the study of blood flow in the endometrium. Its ability to spread can be recognized by the number of vessels in the active tissue.  The big problem with staging endometriosis (or endometriomas) are the cysts that follow it.  Because of its capacity to spread in most areas of the body, a strategic protocol for clinical management is to conduct IMAGE GUIDED treatments, whereby use of real-time scanning of or during therapeutic process helps navigate the focus the treatment area.  Imaging solutions include CT (which has radiation), MRI, or the 3D Doppler ultrasound. 

CASE REVIEWS: We recently had a case where the endometriosis had metastasized under the arm. We've seen it metastasize in post-op scars. We can see the endometrial tissue block the ureters- hence, blocking the kidneys and destroying the kidney function.  Moreover, the scars can cause bowel obstruction.

While it's not categorized as malignant, it certainly can be deadly (as well as a seriously painful and debilitating disease). Women (especially those in advanced age groups) have expressed being completely incapacitated for three out of four days during their menstrual cycle.  A vast majority of them also claimed experiencing mental health issues because of the pain and discomfort. 

The following slides are from Dr. Robert Bard's lecture presented in 2016 for the obstetrics and gynecology department at Mount Sinai Medical Center in New York City (ref: prior lecture from Harvard Medical School/the American Institute of Ultrasound in Medicine).

Use of the modern image guided treatment technologies offer non-invasive blood flow technology, which quantifies the aggression, either the aggressiveness of an inflammatory process like endometriosis or the invasive and metastatic potential of cancers such as endometrial cancer & cervical cancer.

FIG 1: Upon observation, this it is not a primary bladder cancer. This is an inflammatory mass because the vessels are smooth (cancer vessels are wrinkly)- and there is a visible difference between the two.  This is a three dimensional pelvic floor doppler study of the pelvis. If we start with scan A, we see the uterus on the bottom half and the bladder on the top, which is black, and within the black fluid is a mass. By looking below that, we see the (scan C and D) the abnormal blood vessels of the endometriosis. Hence, inflamed tissue is vascular and the same pattern of blood vessels from the abnormal endometrium is also in the bladder, indicating that the endometrial tissue has either invaded or metastasized into the base of the bladder. The two scans (B & D) show the bladder wall is intact. Hence, these are endometriosis that has metastasized or spread to the base of the bladder. 

FIG 2: In this image set, we have an endometrioma, which is (again) a large black area where the fluid is black, and within it, there's another nodule with the circle indicated by the red highlight.  We see that there's no blood flow in this- hence, it's not a primary cancer of the bladder.  In addition,  it is not particularly active inside the bladder, however, there is a stalk that is feeding blood vessels to the cystic area.  With the 3D Doppler, we can quantify the cyst in seconds, because 3D takes a dataset in 15, 20 seconds of a hundred, 150 pictures of the whole area, including the blood flow.  

Notice the 3D images on the left with the red circle (Scan A) is the endometrial cyst, which is black, and the circle shows a small nodule within the cyst. What's important with this as contrasted to the previous study is this is NOT VASCULAR, which means this is inactive or subclinical at this time. On the right (E,F,G,H), we see that the pedicle that's going to the cyst and feeding the cyst, the area has multiple blood vessels in it. Because we're using 3D volumetric technology, we are able to quantify the number of vessels in the pedicle. The more blood vessels in the pedicle, the more aggressive the disease is. So back to the cyst. The cyst, there were no vesicles, but the pedicle feeding the cyst had a 13% ratio of blood vessels to assisted tissue. 

EPILOGUE

Traditional medicine has not assisted with the mental depression, the anguish of the certainty that the pain will be monthly and the possible side effects including infertility. Since we've been using targeted therapies with lasers and focused ultrasound energies years ago, we are now globally using bioenergy treatments that is the near infrared laser and the pulse electromagnetic fields to calm down the, the inflammatory process of this inflammatory disorder.

ROBERT L. BARD, MD  (Diagnostic Imaging 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. His most recent program is dedicated to the reporting of mental health diagnostic and innovative solutions including the use of modern neuromagnetic technologies and protocols in his MEDTECH REVIEWS program. 

ENDOMETRIOSIS 2023: FROM ESSENTIALS, ADVANCEMENTS TO FIELD REVIEWS

EDOMETRIOSIS RESOURCE GUIDE: GENE EXPRESSION 

To address endometriosis more effectively, we first need to understand what causes it. And it turns out it's not so simple. 

The Biology of Endometriosis
Endometriosis is a complex disease, which means that there is no single cause and no single answer. It is well known that endometriosis is very much linked to hormones, especially estrogen and progesterone. Gene expression research is providing many clues about other biological systems that contribute to endometriosis. These include inflammation and oxidative stress, processing of toxins – including chemicals called endocrine disruptors, blood vessels, and even repair of our DNA. While this can seem overwhelming  , it’s also opening up new opportunities for better diagnostics, earlier detection, and more effective treatments by addressing the root causes.

Gene Expression
Genes are sections of your DNA that carry the code for proteins that run everything that goes on in your body. On top of this, epigenetics is another layer that turns these genes on and off – like a light switch. Together, they support the proper functioning of our biology by ensuring that we are making the right proteins at the right time. 

While endometriosis has a clear inherited genetic component, it is equally influenced by the environment. This means that the choices you make, along with the experiences and exposures you have in your lifetime, can impact how your genes and body function. Though you can’t change your genes, you CAN influence how they get expressed and thus affect your health – and potentially the health of future generations.

In this Endometriosis Resource Guide, you’ll learn simple strategies to optimize your body’s own biology. It’s a powerful tool to help you regain some control back from a disease that all too often feels like it’s controlling you.

Simple Strategies to Transform Your Stress
Stress is everywhere, but what is it really?  In a nutshell, stress is any influence on your physical, mental, emotional, or energetic systems that creates an imbalance. A small amount of stress is actually healthy. 

Think about when you experience sore muscles in the early stages of a new exercise routine. The stress on your physical body gives a signal for the tissues to become stronger or more flexible.

Your body adapts and gets back into balance, better and healthier than it was before.

But feeling stressed over a long period of time is different. It depletes your body so that you don’t function at your best. You can’t think as well, your decision-making is off, your relationships suffer, and you feel too tired to do what you love.

Whether it’s a nutrient deficiency, exposure to toxins, overexercising, difficulties in relationships, insufficient sunlight, sleep deprivation, hormonal imbalances … ANY imbalance in the system creates stress. Stress then creates downstream imbalances in every system linked to health – including inflammation and oxidative stress.

Stress and Endometriosis
In this graphic, you can see how stress is linked to every aspect of endometriosis. It is a central component that influences both your biology and symptoms. Because of this, it is a key part of any strategy to address your disease.

Your Personal Stress Blueprint

What bothers me isn’t what bothers you. Why is that?  We are each unique in how we respond to stress. Uncovering your personal keys can transform how you approach stress - and your life.

Here are some simple strategies you can implement today. Each strategy can influence stress through gene expression and energetic balance. Together, they are much more powerful.

Your Guide to Healthy Gene Expression
Here are some simple strategies you can do to support and balance all of these biological systems, including stress, through healthy gene expression.

Eat Healthy Food
Food talks to our genes and provides critical support for biochemistry. The Mediterranean diet is the healthiest overall way to get what your body needs. Include more of the good stuff:

• Vitamins and minerals

• Phytonutrients

• Fiber

• Healthy fats and proteins

Minimize or eliminate the bad stuff:

• Processed foods

• Refined sugar

• Alcohol

 

Move Your Body
QMovement is more than exercise for weight or appearance. It’s part of a body-wide communication system, so aim for at least 60 minutes daily. Vary it and make it fun! Ideas include:

• Run, walk, hike

• Workout at gym

• Bike

• Swim

• Dance

• Gardening

• Play

 

Get a Good Night’s Sleep
Sleep is an active state of repair and regeneration, and is linked to every biological system through circadian rhythm. This means it’s not just about how much you sleep, but also when you sleep.

• Aim for 6-8 hours a night between 9 pm and 7 am. 

• Avoid night shifts and frequent travel across multiple time zones.

• Address issues that interfere with sleep including snoring, sleep apnea, and restless legs.

 

Minimize Toxins
Toxins directly and indirectly damage DNA and alter biological processes. Minimize your exposure to endocrine disruptors and other toxins found in many places including:

• Pesticides

• Home cleaning products

• Plastics

• Personal care products

• Air and water pollution

• Smoking

• Medications

 

Manage your Stress

Stress is a response to internal and external events, including thoughts, beliefs, and trauma.While you cannot avoid stress, there are many strategies for managing it so it doesn’t have a big impact. Here are some common ones; find what works for you. It’s good to practice several approaches so you always have the right tool at the right time:

• Meditation

• Massage

• Energy work

• Creative outlets

• Nature, Pets

• Connection & Hugs

• JOY

 

Love yourself. Create your best life!

 

ULTRASOUND DIAGNOSTICS OF ENDOMETRIOMA By: Dr. Robert L. Bard According to the World Health Organization, Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.  It is a chronic disorder that can result in life-disrupting pain during menstrual periods, sexual activity and urination.  Currently, there remains no known cure for endometriosis, whereby treatment is usually aimed at managing its known symptoms.  One objective of the medical community is to conduct early diagnosis and research continues to pursue effective treatments. [1] Endometriosis starts in the endometrium with abnormal cellular proliferation.  Through the use of 3D Ultrasound, this disorder can be measured through the monitoring of the widening or the increased tissue in the endometrium.  Another form of quantitative measure is by the study of blood flow in the endometrium. Its ability to spread can be recognized by the number of vessels in the active tissue.  The big problem with staging endometriosis (or endometriomas) are the cysts that follow it.  Because of its capacity to spread in most areas of the body, a strategic protocol for clinical management is to conduct IMAGE GUIDED treatments, whereby use of real-time scanning of or during therapeutic process helps navigate the focus the treatment area.  Imaging solutions include CT (which has radiation), MRI, or the 3D Doppler ultrasound.  CASE REVIEWS: We recently had a case where the endometriosis had metastasized under the arm. We've seen it metastasize in post-op scars. We can see the endometrial tissue block the ureters- hence, blocking the kidneys and destroying the kidney function.  Moreover, the scars can cause bowel obstruction. While it's not categorized as malignant, it certainly can be deadly (as well as a seriously painful and debilitating disease). Women (especially those in advanced age groups) have expressed being completely incapacitated for three out of four days during their menstrual cycle.  A vast majority of them also claimed experiencing mental health issues because of the pain and discomfort.  The following slides are from Dr. Robert Bard's lecture presented in 2016 for the obstetrics and gynecology department at Mount Sinai Medical Center in New York City (ref: prior lecture from Harvard Medical School/the American Institute of Ultrasound in Medicine). click to enlarge Use of the modern image guided treatment technologies offer non-invasive blood flow technology, which quantifies the aggression, either the aggressiveness of an inflammatory process like endometriosis or the invasive and metastatic potential of cancers such as endometrial cancer & cervical cancer. FIG-1: Upon observation, this it is not a primary bladder cancer. This is an inflammatory mass because the vessels are smooth (cancer vessels are wrinkly)- and there is a visible difference between the two.  This is a three dimensional pelvic floor doppler study of the pelvis. If we start with scan A, we see the uterus on the bottom half and the bladder on the top, which is black, and within the black fluid is a mass. By looking below that, we see the (scan C and D) the abnormal blood vessels of the endometriosis. Hence, inflamed tissue is vascular and the same pattern of blood vessels from the abnormal endometrium is also in the bladder, indicating that the endometrial tissue has either invaded or metastasized into the base of the bladder. The two scans (B & D) show the bladder wall is intact. Hence, these are endometriosis that has metastasized or spread to the base of the bladder.  click to enlarge FIG-2: In this image set, we have an endometrioma, which is (again) a large black area where the fluid is black, and within it, there's another nodule with the circle indicated by the red highlight.  We see that there's no blood flow in this- hence, it's not a primary cancer of the bladder.  In addition,  it is not particularly active inside the bladder, however, there is a stalk that is feeding blood vessels to the cystic area.  With the 3D Doppler, we can quantify the cyst in seconds, because 3D takes a dataset in 15, 20 seconds of a hundred, 150 pictures of the whole area, including the blood flow.   Notice the 3D images on the left with the red circle (Scan A) is the endometrial cyst, which is black, and the circle shows a small nodule within the cyst. What's important with this as contrasted to the previous study is this is NOT VASCULAR, which means this is inactive or subclinical at this time. On the right (E,F,G,H), we see that the pedicle that's going to the cyst and feeding the cyst, the area has multiple blood vessels in it. Because we're using 3D volumetric technology, we are able to quantify the number of vessels in the pedicle. The more blood vessels in the pedicle, the more aggressive the disease is. So back to the cyst. The cyst, there were no vesicles, but the pedicle feeding the cyst had a 13% ratio of blood vessels to assisted tissue.  EPILOGUE Traditional medicine has not assisted with the mental depression, the anguish of the certainty that the pain will be monthly and the possible side effects including infertility. Since we've been using targeted therapies with lasers and focused ultrasound energies years ago, we are now globally using bioenergy treatments that is the near infrared laser and the pulse electromagnetic fields to calm down the process of this inflammatory disorder.

Introduction: by Roberta Kline, MD 

Under a joint report with the Women's Diagnostic Network and HealthTech Reporter, our editors met with Ms. MJ Smith, a clinical ambassador from Screen Point Medical (breast imaging AI) at the 2023 NYC Roentgen Society conference. At the height of the medical conference, we found MJ to be a uniquely profound and engaging speaker about women's health topics.  Exploring a private connection opened us into a collaborative and educational journey befitting our UNDERDIAGNOSED WOMEN series where MJ is truly a life-long supporter of diagnostic care, innovation and non-invasive options.

Endometriosis (sometimes called "endo" for short) is a common health problem in women that is reported to affect more than 11% of American women between 15 and 44. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. When this tissue is found in locations outside of the uterus, it is called endometriosis. Most often this involves the nearby organs and tissues – ovaries, fallopian tubes, outer surface of the uterus, bladder, bowel and rectum. It can also be found in other locations including the vagina, cervix, vulva, or even distant tissues such as the lungs, brain, eye, and skin. Just like the lining of the uterus, this tissue responds to cycling hormones to grow. But unlike normal endometrium, it is not limited to the surface and does not shed. Because of this, it builds up and creates inflammation, scarring, and other changes that contribute to the most common symptom: pain. 

While endometriosis is most often diagnosed in women in their 30s and 40s, it likely develops much earlier. Due to the wide range of symptoms that women can experience, and lack of effective and noninvasive diagnostic tools, women often suffer for years or even decades. Currently the only accepted way to diagnosis endometriosis is to directly visualize and biopsy the lesions with surgery. This is limiting for two reasons. First, endometriosis has to be considered as a possible explanation for symptoms that are often seen as “normal” for menstruating women. Second, the risk of not knowing has to outweigh the risk of potential complications of invasive surgery. 

Endometriosis can also make it harder to get pregnant, and it is not uncommon for a diagnosis to be made only as part of evaluation or treatment for infertility. Getting a diagnosis to explain symptoms is only the first step in addressing endometriosis, however. There is no cure, and most current treatments often come with significant risks or side effects but do not fully resolve a woman’s symptoms. While research progresses slowly, we still do not have a clear understanding of what causes endometriosis, how to diagnose it early without invasive procedures, how to ease symptoms, and ultimately treat and possibly cure the disease itself.

This special interview features great insight from a woman’s journey with endometriosis.  We explore her remarkable quest for answers from the range of pain relief to therapeutic treatments to risks of surgical solutions.

LIVING WITH ENDOMETRIOSIS:
From an interview with MJ Smith

My personal and professional missions are both in women's health. By day, I work for a breast AI company focused on helping radiologists find breast cancers on mammograms. I chose this path because I believe in advancing causes that support women's health simply because women are core members of our culture and our families. I have had two family members, both maternal aunts, who died of breast cancer, - one at the age of 36, and an the other at the age of 52.

Advocacy for Endometriosis is directly related to my personal journey. Growing up with endometriosis since puberty, I've been to the emergency department probably over 20 times for pain or pelvic pain related conditions. The pain had me flat on my back for days at a time or falling out of bed with pain.  I drove myself to a Planned Parenthood in Minnesota where I grew up and was prescribed birth control to manage it well into my twenties.  Despite the hormonal treatments, I still had a series of episodes. 

Endometriosis is the uterine tissue that grows and implants itself outside of the uterus. Going through that pain is the result of a complex process, resulting in swelling and bleeding inside the interstitial spaces of my body. Women who have endometriosis also often develop painful cysts on their ovaries. 

I think the biggest reason you see women in the ER is pelvic pain. Women with chronic pelvic pain (which is often what endometriosis causes) are underserved by the healthcare community because we're constantly complaining of pelvic pain.  The ER is not where you want treatment because you see a different doctor every time you get admitted. With emergency imaging, you usually get a pelvic ultrasound where cysts can show up and they're quick to assume that you have a cyst, or a cyst has burst and this is why you're uncomfortable.  I think now you can do a pelvic MRI with contrast media- but it's still not enough to offer a definitive diagnosis.  (To be continued below)

I found in the 20 years of suffering endometriosis that the only way to get a true diagnosis has remained to be a laparoscopic or an open pelvic surgery. It's incredibly difficult. 

I know another woman who struggled through over seven years of infertility and it was only after seven years, and by then she was well into her late thirties or early forties, that she had surgery to identify endometriosis. Only then was that woman able to get pregnant. I have had a similar experience. I wasn't suffering infertility, but I was in so much pain in my late twenties that my doctor recommended a laparoscopic exploratory surgery because the pain is was so severe. I remember I was prescribed a month's worth of Vicodin leading up to the surgery. I am not a person who developed an addiction to pain medicine- but in retrospect this was done in the time when the entire country fell into a pandemic of addiction to pain medicine. I wouldn't have gotten that prescription in this day and age in 2023 if I have pelvic pain.  Overall, there's no relief for me and over-the-counter meds that do not help. I just thank God I didn't develop an addiction after having taken Vicodin multiple times a day for a month leading up to that surgery... where, in fact, I was diagnosed with stage four endometriosis. 

One of my ovaries was almost lost due to endometriosis. My doctor was able to keep that ovary and as a result I was able to get pregnant with my first child. I had a second child years later but surgery comes with complications. To this day, at 44, I recently went to the emergency department because of pelvic pain and it's still something I live with. I do take hormones but I've given up on looking for answers from academic research because I think that, in my opinion, I don't think we've gotten very far. The choice of hormones have side effects like an increased risk of breast cancer or uterine cancer. I'm very interested in minimally invasive treatment procedures but I just think we've come to a standstill with the traditional medical community when it comes to endometriosis.

---

SEXISM IN THE WOMEN'S HEALTHCARE

by: Mary Nielsen

Many women suffer with undiagnosed endometriosis. The medical field has prided itself on providing objective observations because it claims to rely on science. However, sexism lurks in hospitals, clinics and other health care facilities and the gender gap in treating pain is real. Diane Hoffman and Anita Tarzian from the University of Maryland, Francis King Carey School of Law published, "The Girl Who Cried Pain, A Bias against Women in the Treatment of Pain." Although that study is 20+ years old, little has changed.

Sexist stereotypes that see women as 'emotional' and consequently medical staff doubt a physical basis for women's pain. Men are viewed as more 'rational' and when men say they are feeling acute pain, their symptoms are taken more seriously and considered to have a physical cause. This means women receive very different care for pain management and pain diagnosis. Researcher, Karen Calderone found that women are more likely given sedatives as an answer to complaints of pain and are perceived as being anxious.

Medical professionals focus on returning the woman to a state of being calm and not investigating the cause behind their pain. The sedatives can then make the women seem calmer from outside appearance, while their medical condition can continue to worsen as they remain undiagnosed. Undiagnosed endometriosis has enormous repercussions for a woman. Life altering heavy bleeding, cramping and pain can lead to infertility, anemia, and internal adhesions requiring surgery. 

Education toward gender bias and addressing women's pain is needed to allow earlier diagnosis with a non-invasive technology like ultrasound. 

---

CONTRIBUTORS

Robert L. Bard, MD, DABR, FAIUM, 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’s medical career began as a diagnostic radiologist and evolved into the practice of non-invasive 3D imaging with ultrasound, MRI and laser technologies. He has served in the military, been the head Radiologist at several leading hospitals, and published a multitude of textbooks and scientific papers. He presents articles worldwide, teaches at International Conferences and is on the Editorial Review Board of National and International Medical Journals. Holding medical licenses in several states, he holds Board certification from the American Board of Radiology (1974) and Fellowship in the American Society of Lasers in Medicine and Surgery (2014)

BOBBI KLINE, MD (Educational Dir. /Women's Diagnostic Group)

Dr. Kline is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://bobbiklinemd.com 

MARY NIELSEN (Founder/ Faculty Director - Spectrum Advanced Aesthetics)

Mary established and manages a certified aesthetics institution in Portland Oregon supporting the academic leadership and technical ability to grow a med spa profitably. Through collaborative relationships with evolving aesthetics business, her programs (Fearless Beauties and Cascade Aesthetic Alliance) functions to help the esthetician, whether newly licensed or a veteran with education and networking. She is also a published author of best selling textbooks in aesthetic wellness including ADVANCED AESETHETICS and FEARLESS BEAUTIES. Mary is dedicated to bringing change to the esthetics/beauty industry through comprehensive education and empowerment through knowledge.  https://www.fearlessbeauties.org/

---

2024 CLINICAL PROFILE OF THE DENSE BREAST PARADIGM - for the Obstetrics & Gynecology Society    Written by: Roberta Kline, MD   |   Published by ICRS Medical Press Ltd.

Breast cancer affects the lives of hundreds of thousands of women every year and is a leading cause of death.  While we have made great progress in advancing earlier diagnosis and more individualized treatments, we still need to improve our approach to achieve our ultimate goal - prevention. This requires a deeper understanding of the molecular mechanisms and the multitude of factors that contribute to the development of breast cancer.  

Dr. Roberta Kline, recognized speaker and publishing crusader for women's health brings you a comprehensive review and a deep-dive analysis of the current research  findings about breast density and its major risk factors for breast cancer.  Her reports uncover current imaging practices and clinical protocols updated in great support of breast density detection and the means of addressing this growing condition that affects over 45% of the female population. "Knowing a woman has greater breast density is a critical first step, but it doesn’t end there... we need to go further by understanding the causes of breast density, and how they relate to breast cancer-- we now have another avenue to proactively intervene to reduce risk or even prevent breast cancer in the first place."  This textbook is a champion in targeting the Dense Breast Paradigm as a blueprint and a clear course study for all clinical professionals who are dedicated to women's early detection and prevention programs. (More information)

---

2023 BOOK LAUNCH: "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS"

10/21/2023 - After two years in the making, we congratulate Dr. Robert Bard and his alliance of clinical experts for the launch of "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS".  Springer Medical Publishing proudly presents the first installment in clinical aesthetic procedures. This detailed and up-to-date overview of image-guided procedures focuses on the many aesthetic and reconstructive strategies delivered by some of today's renowned leaders in the clinical aesthetics community. They share their valuable expertise and field-based findings throughout this feature-rich textbook. The wide list of audiences for this text (ie. dermatologists, plastic surgeons, aestheticians, general surgeons) will enjoy an insider's look at each treatment program while providing remarkable field-based knowledge for the general non-medical audience seeking the latest information in non-invasive and minimally invasive aesthetic procedures.

Produced and edited by Dr. Robert L. Bard, (NYC based cancer diagnostic imaging specialist) this collective project showcases the most highly sought-after cosmetic treatments in each priceless chapter- through detailed breakdowns, experiential insights and a generous graphic tour of before and after progress visuals.  Thanks to the additional safety benefits of clinical imaging, our treatment professionals express added confidence in the pre-operative and post-op areas. In addition, many aesthetics procedures noted also brings significant advantages (of accuracy and efficiency) to the actual treatment process from real-time image guidance. 

---

WOMEN’S HEALTH DIGEST

From the publishers of THE WELLNESS JOURNAL and the WOMEN'S DIAGNOSTIC NETWORK NEWS comes a consortium of IPHA'S top professional contributors in women's health & wellness advocacy. Subscribe to our latest community E-news forum and get the insiders news on pain therapeutics, diagnostics and lifestyle upgrades. We welcome special guest contributors from all modalities of healing - from practitioners, product innovators and researchers. Also, gain valuable insight from success stories of real people and their experience with WHAT WORKED for them! Get front row access to our latest headlines. Visit: WomensHealthDigest.org

---

LAUNCHING IN 2024: NATIONAL COALITION OF WOMEN'S HEALTH SUPPORT

Professional health orgs, foundations and advocates of women's health disorders (primarily cancers) is uniting to form a national alliance of collaborators. This collective group is focused on "doing more together" as far as exploring new resources, sharing current ideas and addressing a wide range of topics about women's issues. Meetings like our latest Women's Powermeet series discussed the latest in diagnostic and therapeutic solutions while introducing who's who in national crusadership in the advocacy realm. Clinicians are also welcome to discuss patient-dedicated road maps and a more thoughtful health analysis and research-based evaluation. It is this level of commitment to women's health that provides a deeper sense of care for the patient that lends itself to a more holistic and integrative strategy to therapeutics. It is also this philosophy that draws more intuitive and insightful awareness on a global scale to offer collaboration platforms too better share insights on a patient's disorders to seek out better solutions. (See Women's Health Digest)