Thursday, May 7, 2020

Covid-19 Effects on the Lungs + Chest Ultrasound

Written and presented by: Dr. Stephen Chagares
Edited by: Dr. Robert L. Bard & Lennard Gettz (of NYCRA HealthScan News)

 The Coronavirus has been shown to be very lethal to a subset of patients. What happens is that the virus is ingested into the mouth or nose, going down into the back of the throat (called the hypopharynx and the larynx) and then is breathed into the lungs themselves. The lungs are made of millions of little air SACS called alveoli, and the virus gets into these little layer sacks and adheres to the inner lining. That lining is what allows the interface between the blood and the air and the CO2 from the blood is given out. The oxygen from the air is given into the blood. That's how we breathe in oxygen and blow out CO2.

When the virus gets in there and coats that surface, everyone creates some kind of reaction. One is an antibiotic body reaction- which is an immune response. The other thing that happens is a physical inflammatory response where the immune system automatically goes into defense mode and wants to go in and kill the virus. It senses it's there and sends in "defender" cells, and to most people, it can send the proper amount of little soldiers to do the job. But in a small percentage of patients, the body's internal reaction causes too much inflammation causing a large body of fluid to fill up in the alveoli (air sacs) in the lungs. This stops the ability for oxygen to fuse through those air sacks to get oxygen into the entire body, include vital organs like the heart, the brain, the liver etc.  Without oxygen, this could result serious problems like heart and liver failure (and other such symptoms).

To visually identify this problem, existing technologies have to be tuned to track and monitor cardio-pulmonary performance. Chest x-rays or CT/catscans are available and are widely used now- but carry a number of key issues when it comes to regular chest monitoring. Often normal chest X rays are going to miss this because radiation itself will go through the lung tissue and the fluid and it may not show anything too specific. And then a cat scan may show something totally different where you can see how both lungs are all inflamed and have fluid in them.

The newest thought is the "LUNGSCAN" paradigm through the  use of ultrasound technology- as published by Dr. Robert Bard and a number of European experts in this field. The system of checking the lungs for covid-related issues is applied in tandem with (and not instead of) replacing other radiologic testing.  The concept of INTEGRATIVE solutions is about making as many solutions available to the public as you can to support patient treatment. So although chest X rays and cat scans are often used, there's a lot of radiation to them- and that's a major discrepancy to regular testing.

THE COMPLEX PROCESS OF CT IMAGING
If you're in the ICU, taking a "field trip" down to a radiology center is no fun at all.  It's probably the most dangerous part of a patient's day. Just getting switched from everything on the wall to everything portable and then getting them down and transferring them first from their bed to the stretcher, and then another stretcher into the cat scan table- can be quite harrowing. And then everyone has to get out and leave the patient there. And all the tubes still have to work. And as they come through to make sure nothing pops off and then they have to get transferred back onto the stretcher, up into the elevator, back into the ICU, back into their bed, and then hook everything back up again. So yes, cat scans work great, but there's a lot to it.

PORTABLE IS "IN"
Though we still have the high-powered center units the size of a washing machine, today's ultrasound technology design has been streamlined to offer PORTABLE versions to respond to its many field applications and demands. An "all-in-one" touch screen with detachable probes can be used at the bedside or in any kind of radiologic facility. It is also used in triage units, battlefields, ocean liners, helivacs/ambulances and even the space station.

You can expect to see "LUNGSCAN STATIONS" open up everywhere for outpatients to get quick lung scans (about a 5-minute experience) in urgent care centers per se.  The accuracy, speed and low prep combination of ultrasound alongside our new TeleMedicine trend makes for a SAFER alternative to imaging.



Ultrasound for Critical Care and Regular Covid Monitoring of Respiratory Pathogens

Adding to the arsenal of diagnostic solutions for the Covid-19 respiratory pathogen, the LUNG (or CHEST) ULTRASOUND is making great strides in triage facilities and bedside monitoring.  A growing community of European health specialists are joining a procedural movement to "replace" the dependency on stethoscopes with portable ultrasound use to check a patient's immediate cardiopulmonary condition. For Covid-positive patients, today's ultrasound excels in getting immediate answers safely without radiation - allowing for screening and repeated monitoring. Such is the case in this test sample.

According to radiologist Dr. Robert Bard, indication of the presence of Covid-19 will show in the form of B-LINES (or the 2 vertical rays). "B-Lines specifically mean that the lung tissue adjacent to the coating of the lung is abnormal- and that's what generates these lines. Normal lung tissue should never have B-lines. If you don't have B-Lines, you don't have Covid in the lungs..."

ULTRASOUND ACCESS TO THE "NEW WORLD" OF MEDICINE
The evolution of the portable ultrasound is now being viewed by many as a diagnostic game-changer for patient care in the field. From an interview with professional technical instructor Michael Thury of Terason Ultrasound, he states "the industry just exploded from 30 years ago with the ability and the confidence that ultrasound can give you. The technology enables the physician to really do a much better job diagnosing the patient. As a clinical trainer with clients worldwide, the boom of telemedicine adds to the success of teaching clinicians how to get the most out of remote ultrasound, but also to have fast and easy access to the physician to read and diagnose the patient from any location!"

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Seeing your doctor (during the coronavirus pandemic) can be more systematic these days. Just come right to an exam room, get the ultrasound examination, go home, and then review those results with your physician via Video chat.  This third imaging option helps augment radiologic testing for Coronavirus effects in the chest area.

I also see the "bedside ultrasound" in the ICU carry huge benefits use. Being able to bring in a portable unit to a patient's room has a major safety element. Ultrasound can see fluid levels and in densities very nicely and with a small amount of training, you are able to use ultrasound to distinguish the density of the fluid in the areas where there is most fluid. This kind of imaging innovation really helped to support the understanding of A.R.D.S. (Acute Respiratory Distress Syndrome) in association with SIRS (Systemic Inflammatory Response Syndrome) where the lungs are majorly affected by these types of illnesses, filling them with fluid.

For regular monitoring of the lungs, ultrasound is a safe (non radiation) bet.  To identify symptoms in the lungs where the fluid can fill up is priceless data as part of early detection. Failure to breathe happens next, where ventilators come in to increase the oxygen level and be able to push through that fluid all caused by this simple little virus that just goes in and wreaks havoc on a small number of patients.

Percentage wise (not small total number), over 60,000 patients had that high reaction and it loops right back to "how do we keep an eye on that"?  Let's say you had grown a virus and then you're discharged. The lung reaction afterwards can be weeks or months until all the inflammation has gone. Some people less, some people more. And if chest X rays don't really see that type of level of fluid and and infiltration of the lungs with water and if cat scans or a lot of radiation, then these outpatient ultrasound sites could provide a literal progression from the discharge date all the way out until it looks like a normal lung again.

To me, that's a sensible protocol for early detection.


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ABOUT THE AUTHOR


STEPHEN CHAGARES, MD, FACS - CANCER SURGEON
Dr. Chagares is a board certified general, laparoscopic, robotic and breast surgeon in Monmouth County, NJ.  He obtained specialty training in breast surgery at Memorial Sloan Kettering Cancer Center. In addition to breast surgery, Dr. Chagares regularly performs hernia repairs of all types, including open, laparoscopic and robotic repairs. He was the first surgeon in his region to perform a robotic hernia repair and remains on the cutting edge of all advanced surgical techniques.  He routinely performs multiple other abdominal procedures, including laparoscopic gallbladder removal.  Dr. Chagares has received numerous awards for excellence and academic teaching, Top Doctors Awards and Patients’ Choice Awards. His philosophy is to provide quality care with a personal touch. He respects the art of surgery and feels honored to treat patients every day. visit his website- drchagares.com


EDITOR / CO-PUBLISHER


ROBERT L. BARD, MD, PC, DABR, FASLMS  - RADIOLOGIST
Dr. Bard is recognized for his specialized work in advanced cancer diagnostic imaging. He 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 and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.


Special thanks to: Alice Chiang and Michael Thury of Terason Ultrasound (https://www.terason.com/) and LonShine Technologies Inc.

Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Thursday, April 2, 2020

EUROPEAN IMAGING COLLEAGUES CONFIRM LUNG ULTRASOUND BENEFITS FOR COVID-19 TRIAGE

April 2, 2020 - Dr. Robert L. Bard, NYC imaging specialist collaborates with an international group of medical leaders including Dr. Danilo Buonsenso (Rome, Italy) who recently published reports about "ultrasound equipment as an effective replacement of the stethoscope.”  Dr. Buonsenso's review presents the valid uses and benefits of Lung Ultrasound in identifying respiratory disorders that may be associated with Covid-19.

Currently, front line physicians in Italy and Spain are reportedly triaging with portable ultrasound units that reduce logistical problems of a chaotic environment and healthcare worker exposure. Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic overwhelming medical providers.  Dr. Buonsenso, at the viral epicenter in Rome, uses sonograms to decide who requires a CT scan.

Sonogram taken under rib cage shows liver (grey) with curved diaphragm-
lung border (white) Arrows point to vertical B lines (white) demonstrating
diseased lung tissue.  The more B lines the worse the disease. Healing is
measured by reduction in the number of B lines
The use of CT lung imaging for COVID-19 has been recognized as the diagnostic standard during our current epidemic. Meanwhile, experts find CT to have  disadvantages like radiation exposure. Respiratory distress creates motion artifacts on images that may simulate pulmonary inflammation. Also, viral pneumonia is not diagnostically distinguishable from other viral inflammations in the lung so the argument for a screening modality is useful to separate the critically ill from those needing outpatient treatment.  This review was stated by Dr. Klaus Lessnau, author of "Atlas of Chest Sonography" (Springer 2003), employs both CT and ultrasound imaging in clinical practice.

Dr. Bard reviews international healthcare and technology updates as part of his continued research in the radiological society. This includes Dr. Buonsenso's national reports about the Covid crisis and the expanded use of lung ultrasound as part of his investigation of children as clinically unaffected carriers.  “The global pandemic demands effective answers toward a cure as well as protection of healthcare workers on duty", says Dr. Bard. "I have the highest regard for the European approach to problem solving both clinically and technologically… applying Dr. Buonsenso’s concept makes perfect sense to me and carries great value in our war against Covid-19.”

Ultrasound probes study the lungs between the ribs to
read the lung surface where most Covid pathology is situated
According to Dr. Bard, Lung ultrasound has been used in emergency rooms since it was introduced to the Mt Sinai Medical School in 2014 and is now used nationwide to diagnose pneumonia (viral or bacterial) in children which spares them unnecessary x-rays since it is so accurate. “It is like an electronic stethoscope since lung disease and heart failure producing pulmonary fluid buildup are diagnosed or confirmed with portable ultrasound units at the bedside. This is considered the best imaging tool to diagnose a collapsed lung in seconds which has proven lifesaving as a time saver for on the spot detection.”

In a recent telehealth conference, Dr. Bard explains how ultrasound probes study the lungs between the ribs to read the lung surface where most Covid pathology is situated.  (Image 1) Portable units have the advantage of containment within a sterile sleeve, preventing accidental viral spread to imaging equipment necessitating full decontamination procedures.  All clinical imaging was correlated with the patient’s oxygen saturation and clinical setting.     The virus has known cardiac toxicity so the same sonogram unit may image the heart for fluid buildup and weakened contraction. This may differentiate heart failure from pulmonary infection in some cases which may have similar clinical presentations.


About Dr. Bard
Dr. Robert Bard currently runs a private imaging center in NYC specializing in advanced 3-D sonography to detect cancer tumors and other health disorders.  He lectures in medical conferences worldwide, runs a cancer awareness program for first responders and is also a publisher of countless educational books and articles about cancer imaging and other health/wellness related materials.

Dr. Bard maintains an active role in supporting the medical community by contributing relevant articles to major health magazines, medical journals and news organizations pertaining to current health concerns. His recent projects include advocating and inserting TELEMEDCINE in the medical community as a safe alternative for patients.  Other projects include an upcoming collaborative textbook series on Covid-19 with a list of top experts in the field.  Dr. Bard is also the president of the AngioFoundation (501c3), as philanthropic organization dedicated to funding and supporting public education about current treatment protocols worldwide. 


About Dr. Buonsenso
Actively practicing as a Pediatrician from Gemelli University Hospital in Italy, Dr. Danilo Buonsenso received his medical degree from the Catholic University of the Sacred Heart in Rome in 2010. He was a resident in The School of Pediatrics in the Catholic University of the Sacred Heart till 2016. From January 2016, he was a Head Director of a social and health developing program in the community of Bureh Town, Sierra Leone which aimed to bring medical and social support to fragile populations. At present, he is a Pediatrician at the Department of Woman and Child Health and Publich Health at the Gemelli University Hospital, Rome, Italy.

Dr. Buonsenso's basic personal skills are in Infectious diseases, Pediatric ER and Pediatric Ultrasonography. He has published almost 50 papers in various journals of Pediatrics and has received various grants such as a Grant as a young collaborator by The Italian Minister of Health for the Bando Ricerca Finalizzata 2018, on the role of NGF on brain function recovery after severe brain injury. (Source)

About Dr. Klaus Lessnau
Dr. Klaus Lessnau specializes in Pulmonology, Sleep Medicine, Insomnia Testing, Sleep Apnea Testing, Pulmonary Function Testing.  He is a highly regarded Pulmonologist and a Sleep Medicine specialist with the 14 Street Medical Arts team in NYC. Dr. Lessnau is board certified in Pulmonology, Bronchology, Sleep Medicine Disorders and is a Critical Care doctor with over 30 years of experience. He is also serving as a Director of Critical Care Medicine at Lennox Hill Hospital.


#    #    #

References
1) Is there a role for lung ultrasound during the COVID‐19 pandemic?  - Danilo Buonsenso https://onlinelibrary.wiley.com/doi/abs/10.1002/jum.15284

2) The Lancet: COVID-19 outbreak: less stethoscope, more ultrasound" https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30120-X/fulltext
Danilo Buonsenso | Davide Pata | Antonio Chiaretti - Published:March 20, 2020

3) Dr. Klaus Lessnau, author of "Atlas of Chest Sonography" (Springer 2003) https://link.springer.com/book/10.1007%2F978-3-662-05278-5


Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Tuesday, March 31, 2020

PROTON THERAPY: CANCER TREATMENT TECHNOLOGY IN REVIEW

By: Dr. Robert L. Bard & Grace Davi
Edited by: Lennard M. Gettz / NY Cancer Resource Alliance

Medical researchers and developers have historically pursued many similar considerations in the path to improving cancer treatment solutions—much more than simply "killing cancer tumors."  The highest priority is typically given toward patient safety and well-being during and after treatment due to the use of highly powerful foreign elements like radiation and chemicals with heavy toxicity levels.

Such is the case with conventional X-ray (photon) treatments like intensity-modulated radiation therapy (IMRT), which has proven to be successful in killing targeted tumors but also can damage nearby tissue, thus causing injury to the patient.  IMRT applies high doses of irradiation in order to penetrate the body and reach the depths of the targeted tumor. This powerful beam of energy exposes all tissues along its entire path to radiation, including the normal tissues before the tumor and the normal tissues past the tumor.

 An upgrade from using x-rays in radiation therapy came with the delivery of charged (proton) particle beams (originated by Dr. Robert R. Wilson, 1946) to irradiate cancer. This dose is deposited within a controlled range of depth, affecting specific coordinates in the body so most of the dose is delivered to the actual tumor and little or no radiation is delivered to tissues beyond the tumor (called the Bragg peak). This technique, therefore, maximizes the chances of curing patients without cause debilitating side effects, as proton research shows promising results in reducing the damage to healthy tissues and better preserving patient quality of life.

The National Association for Proton Therapy (NAPT) reports that both standard radiation therapy and proton therapy to work on the same principle of damaging cellular DNA of tumor, with the major difference that proton therapy deposits the majority of the radiation dose directly into the tumor and travels no further through the body.  According to NAPT spokesperson Jennifer Maggiore, “The FDA approved this technology over 30 years ago, so it's not necessarily new, but recent advancements have made it more accessible in hospitals, and versions are also developed for single-room systems.” There are large “big scale” installations with a cyclotron that feeds three to four gantries. This takes up a big footprint of space and a major investment of time and money, which has led to the increase in smaller, single-room centers in recent years.

IMPROVING TRENDS IN CANCER TREATMENT
It is commonly observed that surgeons are increasingly using minimally invasive procedures.  Whether it's robotic or video assisted surgeries, we can identify the pattern of new treatment protocols to result in higher quality of life and a reduction in toxicity. In doing so, it allows us, in some cases, to actually improve survival through those same methods of reducing toxicities for patients.

According to Dr. Charles B. Simone II, Chief Medical Officer of the New York Proton Center, “We’re going to see more and more customized treatment; it's not a one size fits all approach to cancer. We are going to have individualized ways to deliver radiation therapy, individualized drugs or immune agents—and then, potentially more synergy between modalities such as radiation with systemic therapies.”

The concept of the pencil beam scanning or IMPT (intensity-modulated proton therapy) has grown widely accepted as the ‘new future’ in radiation therapy.  Originally recognized to treat brain tumors, proton therapy has since found global success in treating prostate, breast, liver, lung, head and neck, and other cancers.

In the recent past, proton therapy has continued to advance in its design and performance. Over the past two decades, the number of academically affiliated proton therapy centers in the United States has grown from zero to 31.  Over the past six years, newer centers have come onboard with pencil beam scanning proton therapy that has enabled IMPT. This new generation of proton therapy allows the radiation to be focused and deposited directly at the tumor, while avoiding normal tissues to an even greater extent than the first generation of proton therapy. Another unique advantage of the pencil beam scanning includes its ability to better sculpt the beam or dose.  To match the beam into the shape of the tumor (which is usually not a perfectly square, circle or rectangle shape) allows the deposit of more radiation into the tumor, as it travels into the patient, with even less radiation deposited in the normal tissues in front of and also after the tumor.

According to Dr. Simone, another recent advancement in proton therapy is the ability for physicians to apply volumetric imaging—or the ability to conduct low dose CT scans daily and immediately (in 3D) before treatment—to the targeted area. Volumetric imaging allows radiation oncologists to directly visualize the tumor, or the area that needs the treatment, without having to rely on bony anatomy as a surrogate, as most proton treatment installations do. Most proton facilities still use X-ray or KV images, rather than a cone beam CT image, limiting the ability to have millimeter precision.

Unlike devices such as the CyberKnife system with a regular linear accelerator that essentially plugs into the wall and generates its own radiation, proton therapy requires its own source of energy to generate the proton therapy. The most common model used by proton centers to generate protons, including at the New York Proton Center, is through a cyclotron—a 10-foot-wide machine that accelerates particles about two-thirds of the speed of light to generate protons. From there, the radiation gets siphoned out of the cyclotron through a beam line that's just a few inches wide, and goes into each of the clinical treatment rooms.

Proton therapy has been shown to reduce the risk of secondary cancers in patients, while decreasing the chance of any long-term complications from the treatment. For some cancers, including for most pediatric cancers, it has grown to be called the de facto standard of care, while for other cancers clinical trials are being conducted to determine it as the preferred treatment for specific patient populations.

FROM THE PATIENTS’ SIDE
After the patient’s radiation oncologist determines that they are qualified for proton therapy, patients would come in for a single preparation appointment, what's called a simulation or radiation mapping appointment.  This is generally done with an image (like a CT scan, a PET scan or an MRI), where the physician will work with a radiation physicist, as well as treatment planning dosimetrist, to map out the tumor in three or four dimensions.  This helps identify how to deliver radiation to that tumor while avoiding irradiation the normal tissues.

“There are several factors that help us determine the right form of treatment: the type of cancer, the tumor location and other patient characteristics. The length of the treatment varies depending on the case,” explained Dr. Simone. “Some patients will go through stereotactic proton therapy, which is generally between one and five day, and others will experience a more conventional treatment that's every day, Monday through Friday, for several weeks. While most treatments with proton therapy are the same number of days as with traditional x-ray therapy, because of the ability for protons to limit side effects, in some cases proton therapy can be administered to patients in high doses per day, leading to shorter treatment times, decreased cost, more patient convenience, and in some cancers better chances of cure.”


THE NEW YORK PROTON CENTER
July 2019 marked the opening of the 140,000 square ft. state of the art proton treatment facility on East 126th Street.  Managed by ProHealth medical group, the New York Proton Center was established under a joint partnership between Memorial Sloan Kettering Cancer Center, Mt. Sinai Health and Montefiore Health System. The New York Proton Center is projected to treat approximately 1,400 patients annually, receiving patients from its consortium partner institutions and from patients throughout the New York metro area and beyond who are looking for the most effective radiation care possible. The center will be one of the few worldwide that is equipped with the newest and most effective proton therapy technology, provided by globally renowned Varian Medical Systems, the worldwide leader in developing multidisciplinary, integrated cancer solutions.


ABOUT DR. SIMONE
Dr. Charles B. Simone, II is the Chief Medical Officer of the New York Proton Center. He is an internationally recognized expert in the use of proton therapy to treat thoracic malignancies and for reirradiation, and in the development of clinical trial strategies and innovative research in thoracic radiation oncology and stereotactic body radiation therapy. He is a National Institutes of Health, National Science Foundation, and Department of Defense funded investigator who performs clinical and translational research investigating the benefits of proton therapy as part of multi-modality therapy for thoracic malignancies. After years of dedication and service to the American College of Radiation Oncologists, Dr. Simone has been named a Fellow of ACRO, recognizing his highly valued contributions to the field. He has published over 340 scientific articles and chapters, given over 210 scientific lectures to national and international audiences, and is the national Principal Investigator or Co-Chair of 7 NIH-funded cooperative group trials (see complete bio- link https://www.nyproton.com/charles-simone/)


CONTRIBUTORS /  EDITORIAL TEAM

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic 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. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

GRACE DAVI, Public Health Research Consultant at The RightWriters Group 
Grace dedicated her life's work to intense reporting and data analyses of Cancer-related environmental issues. In addition to content work Grace is also a public advocate for health and safety projects in professional areas and support programs for Infection Prevention branches of health care.  Grace launched her career as a researcher/reporter by pioneering collaborative lab projects in the New York waterways by providing public awareness about contaminants and leaching into county and state aquifer. She combined this experience with   4+ years working with oncologists and cancer immunologists as an editor in medical education. Today, Grace is one of the editors and co-publishers of health related publcations, websites, newsletters and journals including prevention101.org and ImmunologyFirst.org





Special Thanks
The NY Cancer Resource Alliance writing team and AngioMedical Publishing wishes to express its deepest and most heartfelt thanks to Dr. Charles B. Simone II for his kind generosity in sharing his vast knowledge about the science and technology of Proton Therapy.  Special added appreciation also belongs to
 the staff at The NY Proton Center including Patrick Curry and Miriam Mond for their support, and also to Nathaniel Goehring of Berlin Rosen Public Relations and Jane Fort and Jennifer Maggiore of the National Association of Proton Therapy (NAPT) - without whose coordinated efforts this project would not have been possible. 


References:
1) https://www.modernhealthcare.com/providers/proton-center-set-open-new-york
2) https://www.itnonline.com/article/trends-proton-therapy-%E2%80%94-faster-therapy-delivery-single-room-installs
3) https://www.manhattantimesnews.com/proton-powerpoder-de-protones/
4) https://www.mevion.com/newsroom/press-releases/mevion-s250-becomes-first-proton-therapy-system-approved-treat-cancer
5) Video: https://www.youtube.com/watch?time_continue=7&v=MS590Xtq9M4&feature=emb_title



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Monday, March 30, 2020

TRIAGE OF COVID-19 BY LUNG ULTRASOUND

 by Robert  Bard MD, FASL  with contributors: Dr. K. Lessnau, New York with Dr. D. Buonsenso, Rome

The use of CT lung imaging for COVID-19 has been the diagnostic standard for the last few months of the current epidemic.  CT has the disadvantage of logistics (staff, patients, transport) and radiation exposure. Respiratory distress creates motion artifacts on images that may simulate pulmonary inflammation. Since the disease mutates often, frequent imaging may be required. Viral pneumonia is not diagnostically distinguishable from other viral inflammations in the lung so the argument for a screening modality is useful to separate the critically ill from those needing outpatient treatment.  Dr. Klaus Lessnau, author of CHEST ULTRASOUND (Springer 2003), employs both CT and ultrasound imaging in clinical practice.




Ultrasound probes have the ability to screen the lungs for respiratory
issues and is a useful TRIAGE tool- however no radiological device
has been able to identify pulmonary viruses directly
Front line physicians in Italy and Spain are triaging with portable bedside ultrasound units that reduce logistical problems of a chaotic environment and healthcare worker exposure. Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic that is overwhelming medical providers and hospital resources.  Dr. Buonsenso, on the front lines in Rome, uses sonograms to decide who gets a CT scan. This is key since deep cleaning a CT room after a suspected patient shuts the room down for up to 2 hours for decontamination.

Lung ultrasound has been used in emergency rooms since it was introduced to the Mt Sinai Med School (New York) Emergency Department in 2014 and is now used nationwide to diagnose pneumonia (viral or bacterial) in children which spares them unnecessary x-rays since it is so caccurate. It is like an electronic stethoscope since lung disease and heart failure producing pulmonary fluid buildup are diagnosed or confirmed with portable ultrasound units at the bedside. This is considered the best imaging tool to diagnose a collapsed lung in seconds which has proven lifesaving as a time saver for on the spot detection. While it was assumed that children are carriers and not clinically affected, Dr. Buonsenso is actively investigating this population and there are findings that are concerning with the expanded use of lung ultrasound in this understudied group.

Disease of the lung from fluid overload-infection, 
heart failure-produces vertical white lines (B-Lines)
Ultrasound probes study the lungs via the ribs showing the lung surface (where most Covid pathology is situated) and adjacent lung tissue. The abdominal scan with the curved transducer has a larger field of view and affords a rapid assessment of B lines (Fig 1), pleural effusion and frank pneumonia (Fig 2).  Portable units have the advantage of containment within a sterile sleeve preventing accidental viral spread to imaging equipment necessitating full decontamination procedures.  Some infected European physicians are monitoring their disease at home via the B line count-few B lines suggest low grade inflamed lung tissue-increasing B line count calls for more aggressive treatment. All clinical imaging was correlated with the patient’s oxygen saturation and clinical setting.  The virus has potential cardiac toxicity so the same sonogram unit may image the heart for fluid buildup and weakened contraction. This may differentiate heart failure from pulmonary infection in some cases which may have similar clinical presentations.

REFERENCE
Bard R: 3D Imaging of Pulmonary Edema in Proceedings of 2020 Annual  American Institute of Ultrasound in Medicine ;Supplement to Journal of Ultrasound in Medicine  July 2020 (in press)

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

CONTRIBUTING WRITER

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic 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. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.


VIDEO CONSULTS SPIKE AMID COVID- ENTER THE AGE OF TELEMEDICINE



As the global pandemic from this novel Coronavirus continues to fill our emergency rooms, it has also brought the patient care industry to a drastically slow crawl- almost to the point of scaring away caregivers and patients alike from the risk of a lethal contact.  The record numbers of global cases from the highly contagious disease have greatly affected a vast majority of elderly patients and the immune-compromised individuals.  These are the same members of the community who visit their doctors most frequently – making them more susceptible to exposure.

Cancer patients in particular are caught in a dreadful situation where an already damaged or weakened immune system from medical treatments could makes a trip to the cancer care facility could prove to be fatal.  It is a common belief that cancer therapies (and having cancer itself) usually carries the side effect of a weakened immune system- leaving the patient defenseless from any infectious illness, especially viral infections like COVID-19.

A recent update in this medical predicament is the relaunch of the digital patient care and communication program called TELEMEDICINE.  Originally designed as a backup consultation idea for far-away patients, this concept is quickly becoming headline news in the medical field and a sound alternative to maintaining patient care without the worry of breaking the national quarantine.
Recently recognized as “the digital house call”, the use of VIDEO CONFERENCING tools like SKYPE and ZOOM are creating a parallel spike to the number of infected cases with a significant rise in installations and tech upgrades in medical offices nationwide.  Offering this option of a virtual consultation not only maintains safety for all patients and staff, but also streamlines one’s time by completely eliminating travel and time spent in the waiting room.



“Safety is now the number one concern when it comes to medical innovation”, states cancer radiologist Dr. Robert Bard at an interview with MPR news. “The age of Corona can also (someday) be known as the age of TeleMedicine.  This all came down at a time when, fortunately we have this already proven technology that responds to this very health crisis… people no longer have to fear getting sick on the commute to their doctor’s appointment or wait in a crowded room full of strangers with varying health conditions. There’s so much that we can do with our current technology- especially this web-based solution that takes away any concern for contamination or the risk of accelerating anyone’s pre-existing illnesses!”

RISK MANAGEMENT AND THE IMMMUNE SYSTEM
New solutions like TeleMedicine are just some of the ways that the medical community is keeping all patients safe from harm- including the very air in health centers that were supposed to heal them. According to Dr. Aisha Hasan, Immunology research specialist in adoptive T-cell therapy at Memorial Sloan Kettering calls , the Coronavirus infection is largely  an “immune system” issue.

We now know that the most at-risk individuals are those above 65, infants under the age of one, those on immunosuppressant medications (for conditions such as arthritis, lupus, Crohns disease, ulcerative colitis) and cancer patients undergoing chemotherapy.  For anybody who has any disruption in their T-cell immunity (which is what controls viral infections), the risk of contracting the illness is much higher  because this virus appears to have a high level of pathogenicity in the respiratory tract – which is the one area  that can really take off and create havoc in the body.  The “viral dose” or number of viral particles that enter the body impacts the severity of the illness. The unchecked high viral load quickly creates severe inflammation in the lungs, necessitating the use of artificial ventilation.

New prevention measures like TeleMedicine are now being implemented worldwide as part of the social distancing measures that we are asked to follow.  The Covid-19 virus has a dual mode of transmission;  droplet infection and direct contact.  A popular area for sick people are usually places like a doctors office- where coughs and sneezes become droplets in the air that could then be taken in and breathed in by someone nearby.  In the same waiting room, direct contact can also be an easy transporter when someone sneezes or touches their hand, then touches a doorknob, a banister, an armrest, a pen or a magazine.

The majority of the public with a normal immune system can prevent this disease from its fatal effects. But due to its unusually long shelf-life, we can all be carriers that can inadvertently affect others- making this a highly contagious virus.

LEGAL PLATFORM OPTIONS OF TELEMEDICINE
Technically speaking, TeleMedicine is defined as the VIRTUAL ALTERNATIVE to the doctor-patient experience using various forms of communication technology instead of the physical face-to-face dimension.  Thanks to the information explosion of our era, a wide list of web-based platforms are available that allows a private file-sharing or audio-visual exchange.

Meanwhile, regulatory restrictions call for strict privacy and data protection when it comes to TeleMedicine. HIPAA (Health Insurance Portability and Accountability Act ) has been established with the proper safeguards for patient information.  Among its tenets, HIPAA mandates industry-wide standards for health care information on electronic billing and other processes and the protection and confidential handling of protected health information in medical community pertaining to privacy.  To respond to this, custom software, hardware, internet security programs, firewalls, web-hosts and all parts of the communication line of TeleMedicine must comply to specific security and privacy standards.

THE “WIN-WIN” OF REINVENTING PATIENT CARE 
The “virtual house call” has quickly become a seemingly forced upgrade to most medical practices. As a solution that has always been available since the early days of the internet (from paperless office to private video conferencing), the idea of a patient staying home while seeing their doctor is not a luxury at all, but a mandated law to self-quarantine for the safety of that patient and all those they come in contact with.

We can now streamline any doctor visit that means a consult, getting a prescription or a referral with TeleMedicine. Elderly patients or those with chronic conditions may find it difficult (and even precarious) to travel to their doctors' office and sit in a waiting room with other sick people with unknown conditions. Advancing this scenario to an electronic doctor's visit or TELEMEDICINE is an available reality that can easily address this concern. SO MUCH CAN BE DONE FROM HOME!

Other benefits include:  • Convenient & Cost Effective  • No Transportation needed  • No need for time off work or child care  • Eliminate the waiting room   • Quicker access to all specialists  • Improved access to files and prescriptions


POINT OF CARE ALTERNATIVE 1: TELERADIOLOGY
Of course not everything can be done over the internet.  Drawing blood, taking one’s temperature and blood, MRI’s/Ultrasound Imaging and other POINT OF CARE services continue to be done on-site in front of a physical medical professional. But this consideration is now the next growing element of the electronic upgrade trend and is being addressed individually by each service or practice type.

1) SCAN FOR EMERGENCY REMOTE LOCATIONS: 
By combining live access and use of selected portable diagnostic ultrasound technologies, your practice can easily scan many parts of the patient to help detect and diagnose countless physiological, biochemical, neurological or musculoskeletal disorders quickly, accurately and efficiently. Any visiting facility that sees patients can be a Tele-Scan -including emergent care clinics, hospital emergency rooms, PCP's office, PT's, Chiropractors, specialists, ambulatory transport vehicles etc.

TELE-SCANS provide all medical practices with access to portable digital imaging field scanners designed to safely and accurately scan a wide range of organs and issues. Tele-Scan digital ultrasound scanners are powerful enough to capture images, videos and study blood flow from just about any depth in the body. TELE-SCANNING provides effective training on the use of scanning technology for every day patient use.  The concept of TELE-SCAN program are designed to transmit all patients' scans via secure web to our central diagnostic specialists (expert imaging readers/diagnosticians) who can safely and accurately identify any and all issues.

2) TELERADIOLOGY
Through private web portals, physicians anywhere can have access to radiology specialists by enabling file transfer and retrieval of patient images electronically. Doctor-to-doctor collaboration is now made simple regardless of ones physical office location. Image files of varying sizes and applications like x-rays, CTs, Ultrasound files and MRI's are often what is shared. Teleradiology is a great benefit to patient care by allowing radiologists to diagnose, analyze and generate reports on the patient's condition REMOTELY.   TeleRadiology is 24-7 and is accessible from any location--  a major advantage to the medical community because sub-specialists like pediatric radiologists,  neuroradiologist,  MRI or musculoskeletal radiologist are usually found in major cities during daytime hours.

Other Point-of-Care programs will be discussed in PART 2 of this article about “Satellite POC Centers”. 

For more information, visit: http://telemedscans.com/



REFERENCES

https://www.webmd.com/lung/news/20200325/covid-19-may-delay-some-cancer-treatments#1

https://en.wikipedia.org/wiki/Teleradiology


Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Surgeon Uses TeleMedicine for Real-Time Patient Care

By: Dr. Stephen Chagares

Some of the benefits of TeleMedicine conferencing and consulting are that it keeps our social distancing intact while still being able to have a doctor/patient relationship. I can meet patients, we can talk through things, they can have their family there. I can be in my office and show them the computers and posters and show them everything they need, without needing to have a personal interaction and the risk associated with that in this day and age of the Coronavirus.

Some of the examples of TeleMedicine that have been very useful are in the elderly population. Many of them have never used the video function on their phones. And we, as my office helped them learn how to use that function, either bring an app onto the phone or using an indwelling app like FaceTime, and show the patient how easy it is to use it. Many times the first time I click on with the patient, I will implant them onto the video conference. I'll tell them to hit the accept button on the bottom right, and they hit it. And their face, pops back and they're like, "Oh. Oh, there you are." And they are so shocked that it was one click away. That's literally the first thing they always say is, "Oh, this is such a nice way that I can go see my grandchildren or my great grandchildren and not just have it be audio, but be able to physically see them," which really helps a lot in the personal psyche of at all, especially in this era of quarantining everyone.

Yes. I saw a hashtag which was #alonetogether, which really hit exactly what everyone's feeling. Everyone is alone in their homes, but we want everyone to feel that we're all still together. This teleconferencing and TeleMedicine consulting allows patients to not feel isolated. They can see that they can see other people, see their doctors, and keep taking care of themselves, both mentally and medically.

The big picture in the change of everything is that from a surgeon's standpoint, yes, I can follow my post-ops, see their wounds, see pre-op patients, talk about surgery, get everything set up for an operation. And the surgery side of everything right now is really emergencies like appendixes and acute cholecystitis, gallbladder attacks, semi-emergent operations like incarcerated hernias and cancer operations.

From a surgeon perspective, we're still doing some of the surgery, but still doing a lot of the consults. For my fellow medical physicians in other fields, it's equally as important for them. The internal medicine doctors are taking care of all of the COVID patients and all of the patients with flus and all that. But they also have all their maintenance patients, all their hypertension patients, diabetes patients. All of these patients have to make sure they keep having their maintenance healthcare, have to make sure they're keeping up on their blood pressure medicines, their blood sugars. There are blood tests that have to still be drawn.

All these things have to keep still being taken care of, in this era where all the national focus is on COVID-19. So, TeleMedicine consulting for the internal medicine doctors is helping them because they're able to follow their chronic patients, keep them at home, not have them get exposure to the COVID virus, but still have their medical maintenance and still make sure that their diabetes and hypertension, and all of the other medical conditions, are still being tracked. The big issue is that we don't want those controlled chronic medical issues to get out of control, because then that can spiral into an ER visit or even a hospitalization that then becomes much more risky with respect to exposure to the Coronavirus.




..................................................................................................................................................................
STEPHEN CHAGARES, MD FACS 

Stephen A. Chagares, MD, FACS, is a board certified general, laparoscopic, robotic and breast surgeon in Monmouth County, NJ.   Dr. Chagares obtained specialty training in breast surgery at Memorial Sloan Kettering Cancer Center. In addition to breast surgery, Dr. Chagares regularly performs hernia repairs of all types, including open, laparoscopic and robotic repairs.  He was the first surgeon in his region to perform a robotic hernia repair and remains on the cutting edge of all advanced surgical techniques.  He routinely performs multiple other abdominal procedures, including laparoscopic gallbladder removal.  Dr. Chagares is also a specialist in surgical resection of skin and soft tissue cancers.  He has received numerous awards for excellence and academic teaching, Top Doctors Awards and Patients’ Choice Awards.  His philosophy is to provide quality care with a personal touch. He respects the art of surgery and feels honored to treat patients every day. For more information, visit  www.drchagares.com


This article is sponsored by:
www.TeleMedScans.com

http://prevention101.org/









Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Wednesday, March 25, 2020

WHY TELEMEDICINE?

Written by: Dr. Robert L. Bard

The communication features of TeleMed can also be used to
train other doctors in remote locations on new equipment
or modalities in patient care-
One of the current updates in patient care is the advancement of TELEMEDICINE. Thanks to the expansion of our web-based means of communication, doctors and patients are now able to convert the standard office visit to a virtual consultation or a remote, face-to-digital face exchange. Patients enjoy the benefits of the complete elimination of costly travel time and the potential viral exposure of sitting in a busy waiting room.

By definition, TeleMedicine is the implementing of any health-related services and information through the use of electronic and telecommunication technologies. It allows for REMOTE patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Conceptually, TeleMed technologies are used as an alternative means of communication, resulting in a more efficient use of the doctors' and patients' time.  By communicating on a video-conferencing platform, TeleMedicine allows the physician to easily share files, records and imaging on the same screen that the doctor and patient are conducting a private consultation. TeleMed has been recognized to expand the practitioner's ability to reach more patients geographically and in less time- thus growing the medical practice this way.

To date, many new advancements have been added to this growing concept of remote patient care - including REAL-TIME INTERACTIVE SERVICES or "mHEALTH", REMOTE MONITORING (RPM), VIRTUAL CONSULTS (a form of live video conferencing) and STORE-AND-FORWARD (also known as 'asychronous video').Whether it's to reduce medical costs, save time or stay safe from potential (or advancing) health risks, methods of patient care continues to evolve toward better performance and efficiency for the convenience of the patient as well as improved use of time for the provider. This includes the smart use of internet technology and online private portals to offer a virtual alternative to the doctor's office visit.


PATIENTS WITH CHRONIC CONDITIONS & ALL IMMUNO-COMPROMISED ARE AT HIGH RISK

Chronic conditions like lung and heart disease, lupus, and diabetes directly affect the immune system. Also patients diagnosed with auto-immune disorders and cancers (including those currently undergoing chemotherapy treatments) can leave a person immuno-compromised. This makes them a very high risk of contracting deadly viruses like the Coronavirus. Anyone with weakened immune systems are highly advised to stay indoors and prevent any contact with the public. To battle this pandemic the right way, we all need a strong IMMUNE SYSTEM to recover from contamination. Also, ask any of your doctors if they subscribe to TeleMedicine as an alternative to any upcoming office visits.

THE FUTURE OF HOUSE CALLS: A SMART UPGRADE TO DOCTORS VISITS
Within the past several decades, the medical community has been put into overdrive to come up with new solutions (or modify existing ones) to implement safer, more efficient and cost-effective ways of working with the public. From the global demand for active medical personnel, to the rising wave of safety concerns that of the many at-risk patients, we face a great need to upgrade patient care.

Elderly patients or those with chronic conditions may find it difficult (and even precarious) to travel to their doctors' office and sit in a waiting room with other sick people with unknown conditions. Advancing this scenario to an electronic doctor's visit or TELEMEDICINE is an available reality that can easily address this concern. SO MUCH CAN BE DONE FROM HOME!

TELEMED BENEFITS FOR THE PATIENT
• Convenient & cost effective
• No Transportation needed
• No need for time off work or child care
• Eliminate the waiting room
• Quicker access to all specialists
• Improved access to files and prescriptions


Additional Articles (also see):
• Coronavirus Prompts Spike in TeleMedicine Use- By: Dr. Stephen Chagares
• Surviving a Pandemic with Perspective - By: Lennard Gettz
................................................................................................................................................................
CONTRIBUTING WRITER

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic 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. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.



Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.