Wednesday, March 31, 2010

Cairo MEDICON 2010

Folk's we made it to Egypt. We are at MEDICON 2010 preparing to deliver a lecture with hands-on teaching on critical care ultrasound. We are amazed at the sights and sounds of one of the most ancient places of humanity on earth. The cab rides are better than an amusement park ride, and perhaps more dangerous. The wonderful people of Egypt have welcomed us with open arms and we have established friendships in the course of conducting business. Our goal is to bring modern ultrasound to the middle east nations, and this is certainly a logical place to begin. Our hosts have been gracious, the food a splash of color on the western palate. I am certain we will be back. We intend to wrap things up this weekend with a trip to the most magnificent structures on the planet. I am certain I will be humbled when I journey to the great pyramids of Giza. My companions have expressed an interest in riding a camel. I will pass, though I may ride a horse from west to east at dawn in a tourist encounter many of you have experienced. Hey. I am always the seeker of enlightenment. We will then discover the art of purchasing goods from a "Souk". I must not return home without a few gifts. I will be back soon with more news regarding this thread. Shalom!
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Monday, March 22, 2010

Egypt Here We Come

I will be traveling next week to Cairo, Egypt to present a lecture and workshop in critical care ultrasound. This will be our first trip to this ancient land, and I am looking forward to the trip.  We plan to visit the pyramids and maybe some museums along the way.  I will post some images here when we get home.  Details of the conference can be found here:

Therapeutic Ultrasound at home?

Therapeutic Ultrasound has long been a means of treating muscular and bone pain.   Often times, patients would be scheduled to come in for multiple sessions before pain management becomes effective.  This can significantly impact a patients life in that many hours are spent in the hospital, or Doctors office waiting for treatment.  A new device is being tested that could allow patients to take the ultrasound device home with them and administer there own treatments saving both time and money. 
March 19, 2010

View a webcast with George K. Lewis, a biomedical engineering graduate student at Cornell University.
Imagine that after long day tending to patients, a middle-aged nurse feels a burning pain in her knees so intense she can barely walk. For millions of people who suffer from arthritis or other chronic joint pain, this is a familiar story. Right now there are few day-to-day therapies available for these patients, and many involve strong medications that can be harmful over time.  Read more...

Friday, March 12, 2010


I have been watching with interest the development of new technologies in the field of ultrasound for over thirty years. Mile stones I have witnessed include real-time ultrasound (as opposed to B-scanning), color Doppler, 3-D ultrasound and portable high resolution ultrasound machines. A few years ago, one of our part time instructors told me of work her husband was doing in a relatively narrow field of ultrasound called elastography. She said that her husband's research indicated that ultrasound can be used to judge the elastic properties of abnormal superficial tissues, and that the relative stiffness of these lesions can be a predictor to whether the tissue is benign or malignant. Many skin and breast cancers become very hard, fixed and stiff compared to the surrounding normal tissue. Year later, research has proven her words to be true. Many papers have been published regarding the use of elastography in the evaluation of skin lesions, and breast masses. This science has now gained a foothold in clinical use to the point where many ultrasound manufacturers are adding the hardware and software needed to allow their equipment to be used in this manner. The benefits? One obvious benefit is we now have an accurate means of evaluating suspicious breast and skin lesions to allow us to reduce the number of biopsies performed. In the past, we routinely biopsied many masses based on fuzzy parameters in the hopes of avoiding litigation for missing a malignancy. We now have more accurate means to categorize lesions based upon stiffness, which raises our confidence level in establishing benign versus malignant without resorting to invasive biopsies. I will post links to a couple of articles written last year which discusses some specific uses of elastography.

"About eight of every 10 breast biopsies turn out to be benign. Elastography can better distinguish between benign abnormalities and cancerous breast lesions and keep unnecessary needle biopsies from ever taking place, said Dr. Stamatia V. Destounis, a diagnostic radiologist at Elizabeth Wende Breast Care in Rochester, NY."

"Tuesday at the 2009 RSNA meeting Siegel unveiled results of a study that, for the first time, looked at the utility of ultrasound elastography for identifying skin cancers.

Findings suggest that high-frequency ultrasound with elastography has the potential to measure the extent and depth of skin lesions as well as reduce the number of unnecessary skin biopsies."


Thursday, March 11, 2010

Ultrasound and CT: The Debate Continues

Many Americans are aware of the debate raging over the safety of CT scans performed. Issues regarding high radiation doses and appropriateness in the clinical setting have surfaced in recent months through out the media and in the blogosphere. The science behind radiation is clear: there is no such thing as a safe X-Ray. Medical professionals are taught in school that diagnostic X-Rays are to be used in the clinical setting when other, less hazardous forms of medical imaging will not give us the information we seek. Then why is it that when we go to the ED with an stomach pain we are sent to the CAT scanner instead of given an ultrasound? The answers are complex and troubling. In many cases the Physician trusts the result of the CT scan over the result of an ultrasound because they think the CT scan "Cannot miss anything". Many Physicians are under the impression that an ultrasound test is very operator dependent (True) and are loathe to trust the results for fear of being held liable if the test misses something. As a Sonographer, I agree that the results of the sonogram can be influenced by many factors including operator training and the skill of the interpretation, patient body habitus, and type of equipment used, but is CT really the gold standard? Should we really be subjecting our children and women of childbearing age to the risk of X-Rays without giving the matter much consideration? I would like to post part of an article I found on the web that discusses one of these issues. I welcome your feed back.

ScienceDaily (Mar. 8, 2010) — In a bold, eye-opening editorial in the March 2010 issue of the Journal of Ultrasound in Medicine, Harvard Professor, Beryl Benacerraf, MD, urges the medical community to use ultrasound instead of Computed Tomography (CT) as the first-line imaging test for better diagnosis capability in the evaluation of acute female pelvic and lower abdominal conditions.

"How have we evolved to ordering the most expensive imaging technique first for these patients, only to be followed frequently by a far less costly ultrasound examination to clarify the CT findings? Ultrasound is the established modality of choice to evaluate the female pelvis, so why do patients with pelvic masses or pain get a CT scan? In my opinion, doing a CT scan first for female patients with lower abdominal pain is dangerous and wasteful, a drain of much-needed health care dollars."
You can find the article here:

Thank you Science Daily.

Tuesday, March 9, 2010

First in Texas

I am pleased to announce I am the first Sonographer in the state of Texas to use the GE portable ultrasound machine. As you see, it is slightly larger than an I phone, and a wee bit heavier. My GE medical rep, Mr S. Potter brought the instrument over to my office for a test drive yesterday. First Impression: Nice images. Very clear echocardiogram. Nice frame rate, and color flow Doppler that was pretty darn good. No pulse or CW Doppler. Only one sector probe. Three presets: OB, ABD, and Echo. One issue: it got very warm after 10 minutes of scanning, and automatically put itself in an energy saving mode (Wonder if that is connected to the heating???) The energy saving mode reduced the frame rate to 3 hertz. All in all, a great product for a quick look see. More later. Peace....

Saturday, March 6, 2010

Contrast and Molecular Imaging with Ultrasound

An exciting application of ultrasound contrast technology has been recently presented which uses molecular interactions between gas filled contrast agents tagged with substances that bind to tumors. This is exciting because we may be able to spot cancers while they are very small, and treat them before they spread.

"ScienceDaily (Mar. 6, 2010) — An imaging technique combining ultrasound and specially modified contrast agents may allow researchers to noninvasive detect cancer and show its progression, according to research published in the March issue of The Journal of Nuclear Medicine (JNM). The technique enables researchers to visualize tumor activity at the molecular level." Please see the full post here:

Thanks Science Daily. I hope further research is fruitful in this area. This seems like it may be applicable to many types of cancer, and perhaps, other diseases.