WHAT IS PHASE ANGLE? Advacement in Bioenergy Metrics in Regenerative Medicine

Authored by: Dr. Leslie Valle-Montoya

PHASE ANGLE is a measurement used in bioelectrical impedance analysis (BIA)—a technology that sends a small, safe electrical signal through the body to learn about your health. The phase angle tells us how well your cells are functioning.  Your cells are like tiny batteries. A higher phase angle usually means your cells are healthy, strong, and holding their shape well—like fresh grapes. A lower phase angle may suggest weaker or damaged cells—like dried-up raisins. This number can help doctors or wellness professionals understand your body’s overall condition, hydration, and cellular health in our health span.  It’s often used in wellness, sports, and medical settings to track changes, especially during aging, illness, or nutritional programs.

Through the clinical work and mentorship of Dr. Robert Bard (BardDiagnostics NYC) and his recent presentation at the AIUM World Converence, advanced ultrasound systems can reveal the health of tissues in the present moment by measuring health and longevity through carotid artery ultrasound. This test looks at the major arteries in your neck that supply blood to your brain. It can measure how thick or stiff the artery walls are, which tells us how healthy your blood vessels are and how much plaque might be building up. Thinner, more flexible arteries mean better circulation and a lower risk of heart disease and stroke.

Together, phase angle and carotid ultrasound give a deeper picture of your internal health—from your cells to your circulation—and help guide wellness plans that support long-term vitality and longevity.

----------------------------------------------------------------------------------------------------------------------

Phase Angle: The Impact of Regenerative Therapies on Cellular Health

Key Takeaways

● Phase angle has emerged as a useful marker for assessing health risks, including morbidity and mortality, across a range of clinical scenarios. In this study, 22 participants—some healthy and others managing chronic conditions—were included.

● The findings provide average phase angle values for both men and women, offering insight into how these values vary by sex.

● Phase angle tends to increase steadily from early childhood through adolescence, to stabilize between ages 19 and 48, and then gradually to decline with age.

● These reference values can be a valuable tool for evaluating an individual's health status in a clinical setting.

Abstract
This study investigates the effects of regenerative therapies on cellular health and function using BioImpedance and Phase Angle Analysis. A pre-post intervention design was implemented, assessing phase angle as a marker of cellular integrity before and after treatment. Our findings demonstrate a statistically significant increase in phase angle, suggesting improved cell membrane function and overall vitality.

Introduction
Phase angle, derived from bioelectrical impedance analysis (BIA), is gaining recognition as a meaningful indicator of overall health. It reflects the relationship between resistance (R) and reactance (Xc) in body tissues. Lower phase angle values have been linked to cellular stress, membrane dysfunction, and impaired tissue integrity. Factors such as chronic illness, inflammation, malnutrition, and poor lifestyle habits can negatively impact the body’s electrical properties, which are captured in the phase angle. 

Recent studies show that individuals with chronic or acute illness often have reduced phase angle values, potentially indicating accelerated aging and diminished cellular regeneration. Because the phase angle is influenced by cell membrane integrity, cell size, and overall tissue health, having baseline reference values is essential for identifying deviations that might signal underlying health issues.

This study highlights the importance of understanding phase angle across different life stages. As anti-aging and wellness trends continue to grow, phase angle offers a promising, non-invasive window into cellular vitality and the aging process. Methods Study Design This was a single-group, pre-post intervention study conducted at the Santa Barbara Longevity Center. The goal was to assess the effects of a comprehensive cellular regeneration program on physiological markers of health and vitality. Participants underwent testing before and after the  Intervention to measure changes in autonomic function and cellular health.

Assessments
Two primary assessments were used to evaluate outcomes:

● Heart Rate Variability (HRV): Non-invasive HRV testing was used to assess autonomic nervous system balance and stress resilience.

● Bioelectrical Impedance Analysis (BIA): Phase angle was calculated as a marker of cellular integrity and vitality, based on resistance and reactance values. Both HRV and bioimpedance assessments were performed prior to the first session and again after completion of the full program.

Intervention Protocol
Each participant received a series of eight sessions over the course of four weeks. The program included the following therapies at each session:

● Ondamed Frequency Therapy: A bioenergetic treatment using pulsed electromagnetic fields to modulate cellular communication and support tissue regeneration.

● H-Wave Therapy: A form of electrotherapy designed to enhance blood flow, reduce inflammation, and stimulate lymphatic drainage and muscle recovery.

● Red Light Therapy: Low-level light therapy aimed at stimulating mitochondrial function, promoting cellular repair, and enhancing skin and tissue health.

● Infrared Sauna & Cold Plunge: A contrast therapy combining heat and cold exposure to support detoxification, reduce systemic inflammation, and improve circulation and recovery.

All sessions were conducted in a controlled wellness setting and overseen by trained practitioners. Participants were advised to maintain their usual diet and activity levels throughout the study period.

Measurements
Primary outcome measure: Phase Angle (PA) assessed before and after intervention using BioImpedance Analysis. Statistical analysis: Paired t-tests were used to determine significant changes, with a 95% confidence interval (CI) computed for phase angle pre- and post-intervention.

Results
Pre-Post Analysis

● Mean Phase Angle Before Treatment: 6.28 (95% CI: 5.71 – 6.84)

● Mean Phase Angle After Treatment: 6.86 (95% CI: 6.32 – 7.40)

● T-Statistic: -3.39

● P-Value: 0.0037

A statistically significant increase in phase angle was observed, indicating enhanced cellular membrane integrity and metabolic efficiency.

Discussion
The results of this study indicate that the combined use of frequency-based, circulatory, and metabolic-enhancing therapies can lead to measurable improvements in cellular health, as evidenced by a consistent increase in phase angle values among participants. Phase angle is recognized as a reliable marker of cell membrane integrity and intracellular hydration—both of which are essential indicators of biological vitality and resilience. An upward shift in this value suggests enhanced membrane stability, improved cellular function, and better overall physiological status.

Notably, several participants experienced remarkable improvements over the four-week intervention period:

● Subject 1: Phase angle increased from 5.4 to 6.6

● Subject 2: Phase angle increased from 6.0 to 6.9

● Subject 3: Phase angle increased from 6.5 to 8.0

● Subject 4: Phase angle increased from 4.4 to 5.2

These changes are particularly significant given how challenging it is to raise phase angle in such a short timeframe. In clinical settings, even small increases in phase angle are considered meaningful, making these improvements—some exceeding 1.0 or even 1.5 units—especially noteworthy. These outcomes suggest a strong regenerative effect from the combination of therapies delivered during the study.

The interventions likely worked synergistically to support cellular function from multiple angles. Ondamed Frequency Therapy may have restored bioenergetic balance and enhanced intercellular communication. H-Wave Therapy likely promoted microcirculation and lymphatic flow, accelerating nutrient delivery and metabolic waste removal. Red Light Therapy's activation of mitochondrial pathways likely played a role in boosting ATP production and cellular repair. Meanwhile, infrared sauna and cold plunge contrast therapy supported detoxification, reduced inflammation, and enhanced vascular tone. Taken together, the multimodal approach appears to foster a biological environment conducive to regeneration and resilience. These findings are consistent with a growing body of evidence positioning bioimpedance-derived phase angle as a valuable biomarker for health status, aging, and response to therapeutic interventions.

Conclusion
This study provides compelling preliminary evidence that integrative regenerative therapies can significantly enhance cellular function, as demonstrated by substantial increases in bioimpedance phase angle across multiple participants. These results are particularly remarkable given the short duration of the intervention—just four weeks—which typically is not long enough to yield such dramatic improvements in cellular health markers.

The data support the clinical relevance of using phase angle as a biomarker in wellness-focused and longevity-based care. These therapies—ranging from frequency-based modulation to mitochondrial stimulation and detoxification—may play a vital role in improving healthspan and supporting the body's intrinsic repair mechanisms. Future research should aim to expand the sample size, evaluate long-term effects, and incorporate additional objective biomarkers such as inflammatory cytokines, oxidative stress markers, mitochondrial function assays, and epigenetic age testing. A broader dataset could further validate the impact of these therapies and refine protocols for individualized health optimization and age-related decline prevention.

________________________________________________________________________

MEASUREMENT OF CELLULAR VITALITY AND SYSTEMIC INFLAMMATION

By: Matthew Einsohn, RSG

Phase Angle measurements are giving us a way to watch the body rebuild itself — from the inside out. A 9.2% increase in phase angle—from 6.28 to 6.86—in just 4 weeks? That's not just a statistical uptick; it's a substantial leap in cellular health. In the realm of phase angle analysis, even a 0.2 shift is noteworthy. Dr. Leslie Valle-Montoya's preliminary findings underscore the potential of targeted regenerative therapies to effect meaningful biological change in a relatively short time. [1][2]

But here's where it gets even more compelling: phase angle isn't solely a marker of cellular vitality; it's emerging as a non-invasive indicator of systemic inflammation. A study published in Nutrients found that lower phase angle values were significantly associated with higher levels of C-reactive protein (CRP), a well-established marker of inflammation . This association remained significant even after adjusting for factors like age, BMI, and physical activity. [1][2]

Imagine the implications: a simple, non-invasive measurement that provides insights into both cellular integrity and inflammatory status. Now, envision a home-based wellness program—just two sessions a week, totaling eight per month—designed to consistently enhance your cellular health and reduce systemic inflammation.

Why the Medical Trend Is About GOING INDEPENDENT

By: Lennard Goetze, Ed.D

I would never fault any practitioner for the path they choose. For some, working within a hospital system offers structure, consistency, and a sense of security. For others, the pursuit of independence through private practice represents autonomy, innovation, and a deeper connection to purpose. A review of our current practitioners show significant achievements beyond clinical care; some have evolved to publishing and mentoring, others become part of research and technical innovations and yet more push the dial to become award-winning pioneers in the expansion of their specialized study.

Having experienced both models — and having observed countless colleagues navigate both lanes — one can only speak from the vantage point of personal experience. And what anyone can learn from this: "if you’re aiming to make a real difference in the lives of your patients, independence offers a unique kind of freedom".

THE POWER OF PERSONALIZED CARE

I recently finalized a biography of Dr. Robert Bard called "The Cancer Detective's Journal".  He is a board-certified radiologist with licenses in multiple states; he developed and directed over 22 diagnostic health programs focused on cancer, heart disease, autoimmune disorders, wound healing, perimenopausal symptoms, and musculoskeletal injuries — conditions that one could only find medically fascinating but  also deeply meaningful to address. This diversity in services didn’t emerge from a corporate playbook. It came from listening to his patients, staying on top of emerging research, and designing care pathways that respond directly to unmet needs. His ability to constantly evolve is driven by a curiosity and a commitment to his patients — and that kind of flexibility simply isn’t possible within a rigid hospital framework. Systems tend to favor protocols and uniformity. Independent practice rewards innovation and patient-centric thinking.

CLINICAL FREEDOM AND EXPANSION
In his biopic, Dr. Bard stated, "Running a successful private practice does require effort — and more than a little entrepreneurial spirit. It demands that you build a following, manage operations, and sustain a patient workflow that allows room for growth. But in return, it offers something priceless: the ability to expand your expertise on your own terms."

Another role model in this independent thinking is one of his colleagues, Dr. Leslie Valle-Montoya  who retorts, "You’re free to pursue continuing education, add new services, experiment with integrative models, and tailor your offerings to what your community actually needs — not just what your employer permits. That agility translates to a more meaningful clinical life and, in many cases, better outcomes for patients who otherwise fall through the cracks of conventional care."

THE SHIFT TOWARD INDEPENDENT MEDICINE

We're seeing a growing number of physicians opt out of institutional employment and carve out their own space in the medical landscape — whether through solo practice, specialty clinics, direct primary care, or telehealth ventures. And it's not hard to see why. Burnout, bureaucracy, and disillusionment are widespread in corporate health care settings. Independent practitioners are reclaiming the essence of medicine: relationships, responsibility, and results.

Of course, independence isn’t easy. You take on more risk, more responsibility, and often more paperwork. But you also gain the satisfaction of practicing medicine the way it was meant to be practiced — with your judgment intact, your creativity engaged, and your patients at the center of everything.

CONCLUSION: THE ROAD TO IMPACT

Choosing private practice isn’t just a career move. For many of us, it’s a mission. It’s about restoring the doctor-patient relationship, building something that reflects your values, and being accountable to outcomes that truly matter. It’s not the right path for everyone, but for those of us drawn to it, independence isn’t just a trend — it’s a calling.

________________________________________________________________________

"I could not echo the same sentiment more.  Independent practice, although it may seem scary and stressful, it is a "good stress."  Yes, institutional medicine may be right for some providers, but it does not allow the growth and progress that is necessary for optimal patient care or medical innovation, not to mention career satisfaction for many (myself included)". -  ANGELA MAZZA, DO  - Integrative Functional Endocrinology

..................................................................................................................................................................

"I am a pharmacist by training (I own my own clinic), but patients seek me out because I develop a personal relationship with them. I think the art of listening to the patient is gone. Being independent allows the time to listen and that's where the best outcomes are found. I was taught that the new medical paradigm of specialization would allow more time for patients but that hasn't happened and in fact, it is worse as now doctors don't have time to speak to each other. It's tough running a business and seeing patients, but I think it's the only way to meet our patients expectations without being pressured to see more and more patients."  -  SCOTT BERLINER R.Ph. - Life Science Pharmacy

..................................................................................................................................................................

"Being in private practice has given me the opportunity to explore emerging areas in medicine and to incorporate innovative approaches into my care. Unlike in a hospital system, private practice allows me to prioritize what is truly best for my patients in every interaction with total autonomy. That freedom has not only shaped my clinical approach but also fueled my passion for medicine. After 29 years, I can confidently say that private practice has allowed me to stay true to the values that first led me to medicine. The autonomy, flexibility, and ability to deliver deeply personalized care offer clear and lasting advantages."   -   STEPHEN CHAGARES, MD, FACS  - Breast/General/Minimally Invasive/Robotic Surgery 

..................................................................................................................................................................

This article beautifully champions the movement toward independence in medicine, but what truly elevates it is the deeper, unspoken truth humming beneath the surface: independent practitioners aren’t just leaving institutions, they’re responding to a collective cry for something new.  This isn’t about faulting systems, it's about birthing a future that still honors the dream many doctors began with.  They don’t just seek freedom from bureaucracy, they pursue freedom to evolve.  The future of medicine is not “independent or institutional” — it’s integration led by inspiration. This piece plants a flag for a needed cultural shift, and I’d love to see it end with that shared vision: medicine as a living artform, evolving through us all.   - MATTHEW EINSOHN, TN

________________________________________________________________________

"Working as an independent physician has advantages and disadvantages. No one is looking over your shoulder, ready to criticize you if you deviate from corporate policy. Patients are individuals, and their needs do not always match protocol. Most integrative/functional medicine doctors choose to practice independently. They employ primarily evidence-based practices outside the standard of care, which are treatments accepted by medical experts as proper for a particular disease.  As an integrative physician, I prefer the freedom of practicing independently. I enjoy my work, helping my patients, and benefitting from a large community of like-minded experts and dedicated independent practitioners." - Barbara Bartlik, MD (psychiatrist)

________________________________________________________________________

LEGENDS IN ACTION

THE LEGACY OF A SCIENTIFIC TRAILBLAZER: Dr. Robert Langer’s impact on biotechnology and medicine is immeasurable. His work has saved countless lives, improved the quality of healthcare, and inspired generations of scientists. As research continues to evolve, his contributions serve as a foundation for future breakthroughs, ensuring that innovation in medical science remains vibrant and transformative. (see full spotlight)

Long Island cancer support advocate, GERI BARISH shares her uncompromising passion for her life’s work.  As co-founder of Hewlett House, Ms. Barish established a well-loved community learning resource center for cancer patients and their families. She and her staff have been serving the local community for over 28 years and have served tens of thousands of cancer patients and their families. (see full spotlight)

________________________________________________________________________

DR. BARD'S FINDINGS THROUGHOUT TIME

Dr. Robert Bard has been recognized for his research and clinical care as well as his achievements that impacted the scientific community.  His reporting comes from a commitment to move the dial in technology to comport with the current standards in healthcare and its needs for upgrades.  As an imaging specialist and the 'cancer detective', his discoveries historically apply as 'game-changers' in the diagnostic community, where his published work memorialized landmarks that clearly helped affect medicine as we know it today. Here are some of those findings:

1) THE ULTRASOUND / DENSE BREAST DEBACLE

1976: Dr. Bard collaborated with pioneer developer Dr. Henry Leis to mitigate the limitations of Mammography- mainly that "mammo" underperformed when scanning past dense breast tissue (deeming early detection scans of dense breasts as false negatives). Remarkably, Dr. Bard's use of ultrasound imaging provided a reliable and supportive imaging for the mammogram, as it was able to see a tumor clearly through the breast density.

2022: Dr. Bard receives the Ellis Island Medal of Honor for his research achievements in areas of breast cancer diagnostics. His top achievement was for his use of ultrasound to complement mammograpy for scanning dense breasts.

2024: U.S. Legislation was finally passed to mandate communicating breast density in all mammography centers, and the use of ultrasound is supported as a secondary scanning solution.

2) DECODING BIA-ALCL & THE TEXTURED IMPLANT

1978: After witnessing inflammatory conditions from his patients with textured implants, Dr. Bard wrote the first paper on BIA-ALCL, (Breast Implant-Associated Anaplastic Large Cell Lymphoma) a rare type of T-cell non-Hodgkin lymphoma that can develop around textured breast implants

1996 to 2015: One hundred pathologically confirmed breast implant-associated ALCL cases were identified in the United States. Mean age at diagnosis was 53.2 ± 12.3 years. Mean interval from implant placement to diagnosis was 10.7 ± 4.6 years.

2019: Allergan voluntarily recalled its Biocell textured breast implants in August 2019

2023: In Australia, a "national outcry" arose regarding BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), a rare type of lymphoma linked to some textured breast implants, leading to regulatory actions and increased awareness. 

3) MOBILIZING ELASTOGRAPHY TO THE WESTERN MARKET

1997: Elastography is a type of imaging test that checks for tissue, organ or tumor stiffness or elasticity- representing this in a dedicated color scale. As a performance upgrade to the Ultrasound, Transient and Shear Eave (SWE) elastography originated in Europe in the late 1990s, with the FibroScan system (Echosens, Paris, France). It was primarily used for liver assessment, a non-invasive technique, emerged as a viable alternative to liver biopsy for staging liver fibrosis.

2008: Thanks to his research and training in France, Dr. Bard was one of the first radiologists to gain access to Elastography, publishing the text on Elastography of the Carotid Artery/MICCAI and Image Guided Therapy 

2013: The FibroScan system, a commercially available elastography device was approved by the FDA in the United States. The FDA approved magnetic resonance elastography (MRE) software for breast lesions in 2014. 

 

[OUTLINE]

Title: The Independent Advantage: Why Private Practice Still Matters in Modern Medicine

Introduction

• Brief overview of the evolving landscape of healthcare

• Growing dominance of hospital systems and health conglomerates

• The value of the independent practitioner — why the conversation matters

Autonomy and Flexibility

• Clinical decision-making without bureaucratic interference

• The ability to set your own schedule, patient load, and treatment philosophy

• More personalized patient care

Deeper Patient Relationships

• Emphasis on continuity of care and long-term relationships

• Freedom to spend more time with patients

• Greater patient loyalty and satisfaction

Financial Transparency and Control

• Direct control over billing and collections

• Opportunity to innovate pricing or adopt models like direct primary care or concierge

• Investment back into your own business instead of a hospital system

Innovation and Agility

• Faster adoption of new technologies, diagnostics, and protocols

• Ability to customize office environment and services

• Less red tape for trying novel care pathways or holistic modalities

Challenges to Acknowledge

• Administrative burden and business overhead

• Lack of institutional support or large-scale infrastructure

• Navigating payer relationships and referral networks

Conclusion

• Private practice is not for everyone, but it's a viable and valuable model

• Reclaiming medical autonomy, rebuilding trust, and re-centering the doctor-patient relationship

• Encouragement for physicians considering independence to explore it with open eyes

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.