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
