Wednesday, October 9, 2024

Dr. Yvette Groszmann, OB/GYN - What is Sonology? (Ultrasound Imaging)

HealthTech Reporter is proud to present our next expert in the field of imaging. YVETTE S. GROSZMANN, MD, MPH, completed a residency in Obstetrics and Gynecology at Pennsylvania Hospital, Philadelphia. In 2009, she left general ob-gyn practice to pursue a fellowship in ob-gyn diagnostic ultrasound with Dr Benacerraf and is now an expert sonologist in early pregnancy and gynecologic ultrasound. She is a fellow of the American College of Obstetrics and Gynecology, a Fellow of the American Institute of Ultrasound (AIUM), former vice president of the American Institute of Ultrasound (AIUM), Chair of the AIUM Gynecology Community of Practice, and a lecturer at Harvard Medical School. She teaches gynecologic ultrasound to the Brigham and Women’s ob-gyn residents and REI fellows, has co-authored a textbook on gynecologic ultrasound, and lectures nationally and internationally.

 

In a recent interview, Dr. Groszmann shares her vision for improved patient care through the philosophy of direct contact with the patient and ultrasound probe. The concept of investigating and recognizing pathology is more efficiently captured by the physician and she discusses this in an excerpt from HTR newscast.


INTERVIEW TRANSCRIPT from Podcast (AIUM Speaker Series)- 5/2024
I became a Gynecologic Sonologist because two of the other physicians in my group were maternal fetal medicine doctors who also did gynecologic ultrasound, but they were more interested in the fetuses.  I frankly, was more interested in the pelvis. I transitioned over the years and I became a specialist in GYN ultrasound. I co-wrote a textbook on this topic. Maybe half of our practice is second opinions, especially in GYN ultrasound. Ultrasound is not typically performed by the physician. It's performed by sonographers (ultrasound technicians). They're taught very well but there is an added layer of validity when you, the physician is the one taking the images, when you understand the physiology and what you're looking at-- it affects interpretation. Our sonographers are excellent-   there's so much more control in scanning the patient if YOU the physician are the one navigating the probe firsthand.

 




Cohort Study (Part 1)- Dense Breast Scanning Survey / Molloy University: 
ACADEMIC PREFLIGHT STUDY OF ULTRASOUND SCREENING APPLICATIONS FOR DENSE BREAST CASES

Transcript by: Noelle Cutter, Ph.D.
Edited by: Roberta Kline, MD and Lennard M. Goetze, Ed.D

We started working with the Terason 3200t Ultrasound (hereinafter shall be referred to as the Terason) in the summer of 2022. The goal of the project was to be able to scan a limited number of younger premenopausal women under the age of 40 who are more likely to have dense breasts based on their status as being endurance based athletes. We have been exclusively using the Terason based on the recommendation of our lead radiologist Dr. Robert Bard.  The Terason became our lab scanner of choice to conduct the screening of 10 individuals in the lab on a voluntary basis to get a readout for their breast density. Endurance athletes are more prone to dense breast tissue, especially athletes under the age of 40. Mammographic density is the strongest risk factor for non-familial breast cancer among women, especially those under the age of 40.   Metastasis, tumor relapse, and resistance to therapy remain the principal causes of death for breast cancer patients and the lack of effective therapies calls for an improved understanding of the molecular mechanisms driving breast cancer progression. Early identification of mammographic density is an essential step in preventative health.


REMOTE COLLABORATIVE TEAM
The Dense Breast paradigm continues to plague our population of the underdiagnosed and underserved women. uniting with public advocates and legislative change makers like the ARE YOU DENSE? FOUNDATION raises significant public awareness in both the clinical and patient communities (see news feature).  Meanwhile, this cohort study received great support from the medical research and diagnostic society whereby scientific leaders like Dr. Robert L. Bard (diagnostic imaging specialist) and Dr. Roberta Kline (epigenetics expert in women's health) helped to spearhead their own respective areas of study to help offer new insight and data in support of the launch of this field research program.  

PORTABLE, HOSPITAL GRADE AND FIELD FRIENDLY
My technicians and I found the Terason to be "super portable" and upon scanning our first few subjects, we immediately understood why Dr. Bard suggested this brand and model. The picture quality and imaging system is very clear and the user interface is very easy to read. For someone who is not experienced or well trained in using an ultrasound, with one or two training sessions I was able to easily use the machine to work with our volunteer subjects. 


An underlying test is the feasibility of using the Terason itself in actual field work. The portability is astounding (to me). This means we can pack it up. I don't even need any sort of a car. I could throw it on my back and get on a bicycle and bring it to a, uh, a destination.  

Click image to see full scan report
As far as its' performance, my group and I did our own homework about its accuracy and reliability and what we often found was the common statement about it being "battle-tested"- in the EMS world). Targeting the triathlete community, all these features are critical advantages to roadside screening! It's easy to use and even easier to train other research assistants in the lab to use it. And with Dr. Bard (and his expert interpretation) on the receiving end of our scans, that is the ultimate peace of mind and a COMPLETE tele-health scanning paradigm. 


FINAL STATEMENT
Breast density is a key factor in early detection because mammograms routinely miss breast cancer in dense breasts, especially in younger and more athletic women. Ultrasound offers a supplemental scan and peace of mind because it finds the pathology and almost instantaneously distinguishes from a benign cyst from a possible cancer - or a definite cancer. Ultrasound even goes further because if there is a definite cancer or something highly suspicious of a cancer, you can look at the other organs such as the glands under the arm to see if it's spread into the lining of the lungs to see if it's invading the pleura or the lymph nodes in the abdomen or the brain. Since we are now armed with expert diagnostic over-readers and remote collaborative imaging options, I urge our gynecologic and obstetric community to take advantage of this affordable non-invasive screening solution. 



DR. NOELLE CUTTER is a professor of biology, ironman finisher, and advocate for dense breast screening.  United with an expanding research team dedicated to collecting data on women with dense breasts and screening options for these patients, her initiative aims to investigate and gather conclusive information about dense breasts in specific groups- including age, body mass index, and amount of physical activity and the underlying diagnostics of breast cancer tumors. This research program is under a partnership with Molloy College and Dr. Robert Bard, expert diagnostic cancer imaging specialist in NYC and other colleagues from the NY Cancer Resource Alliance. 
 




Epigenetic Research Notes: Profiling the Dense Breast Paradigm
A Clinical Report by: Dr. Roberta Kline


LINKING DENSE BREAST WITH BREAST CANCER
We have known for a very long time that there is an increased risk of breast cancer for women who have dense breasts. Until recently, the research has been lagging in terms of what's the molecular mechanism, why do dense breasts present an increased risk of breast cancer? Without this knowledge, we can’t address the root causes, and are left with a lot of trial and error based on incomplete understanding. 

It's very encouraging to know that currently there are 124 clinical trials ongoing looking at dense breasts and the relationship with breast cancer, anywhere from improved diagnostics, to treatment, to prevention, and, what’s close to my heart, to understanding the molecular mechanisms - what's happening at the cell level, at the genetic level that is causing different women to have an elevated risk of breast cancer.  One of the striking features that we're learning about dense breasts and what is creating that density is the microenvironment, which means the environment in the supporting tissue surrounding the glands. This includes fibroblasts and collagen. It seems that rather than estrogen being the dominant factor, it is inflammation that is creating the increased density of breast tissue. 



 





WHAT'S NEXT AFTER CANCER?

The Importance of Maintaining a Healthy Lifestyle and Monitoring

Written by: Dr. Leslie Valle-Montoya 

Cancer recurrence can occur months or even years after initial treatment, and it’s important to be aware that cancer can return in different tissues, not just where it was originally diagnosed. While this is a challenging possibility, there are proactive steps you can take to reduce the risk and protect your health.

Staying vigilant with regular check-ups, lifestyle adjustments, and continued screenings is essential. Early detection of any signs of recurrence greatly increases the chances of successful treatment. Maintaining a healthy lifestyle after being declared “cancer-free” is not always easy, but it’s vital. We are constantly exposed to environmental toxins in our food, water, and surroundings, so addressing the root causes of disease and making healthier choices is crucial. A nutritious diet, physical activity, and stress management all support overall wellness and strengthen the immune system. I often guide patients in addressing lingering dental infections and maintaining a healthy internal environment, whether by enhancing the microbiome or reducing bodily acidity, which cancer thrives on.

Avoiding smoking, limiting alcohol, and maintaining a healthy weight are also key to lowering the risk of recurrence. By focusing on what you can control—your health and regular monitoring—you empower yourself to stay well and ensure long-term health.





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