DEMO REVIEW: THE DERMUS SKINSCANNER- Dual-Modality Dermatologic Imaging

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By mid-March 2025, Dr. Robert Bard and his clinical imaging team conducted a test-drive evaluation of the Dermus SkinScanner, a dual-modality concept developed in Budapest, Hungary. The handheld unit integrates high-frequency ultrasound, operating in the 20–40 MHz range, with a 12×12 mm dermoscopic optical field. The device is designed to visualize surface features alongside subsurface structures at depths of up to approximately 10 mm. In this initial demonstration, Dr. Bard’s team viewed the system not simply as a new piece of equipment, but as a potentially forward-leaning concept in portable dermatologic imaging that offered a visionary approach to point of care imaging. 

A MULTIDISCIPLINARY SUMMARY OF DEMO-BASED IMPRESSIONS OF A DUAL-MODALITY CONCEPT

By: HealthTechReporter.com

Scope and Intent of This Report

This document consolidates cautious, observation-based impressions of a dual-modality dermatologic concept frequently referred to as the Dermus SkinScanner. The concept, as presented in a limited demonstration, aims to align surface dermoscopy with subsurface high-frequency ultrasound in a single handheld format. The intention, according to the training and materials provided at the demo, is to help clinicians correlate topographic patterns at the skin surface with internal structure and echogenic patterns beneath it. The reviewers—Dr. Robert L. Bard, Dr. Abdel Zerzif, and Dr. Leslie Valle-Montoya—commented strictly on the idea and design intent as they experienced it during a short exposure, not on validated clinical performance.

Nothing in this report should be read as a product claim, superiority assertion, or diagnostic conclusion. All statements from the clinicians reflect observations and professional opinions formed during a demo; they are explicitly not endorsements, guarantees, or proof of clinical utility. Where this document references potential relevance or hypothetical use-cases, such references are offered only to explain why the concept drew interest from the reviewers—not to suggest established outcomes.

Design Philosophy: Thoughtful Engineering for Real-World Needs

The Dermus SkinScanner embodies a design philosophy centered on real-world functionality. Its lightweight construction, intuitive interface, and cloud connectivity are not incidental; they are deliberate choices that reflect a deep understanding of clinical environments. By eliminating internal batteries, the designers have simplified transport logistics, making the device ideal for outreach programs, triage settings, and rural clinics where power sources may be limited. The use of distilled water as a coupling medium maintains acoustic fidelity while preserving the device’s sleek, portable form.

Moreover, the system’s reliance on a dedicated mobile unit ensures a consistent, distraction-free user experience. Clinicians are not interrupted by phone calls or app notifications mid-scan, allowing them to remain fully focused on the patient.

The concept centers on comparative visualization: a dermoscopy view of the surface positioned in a consistent relationship with a subdermal ultrasound cross-section. The demo highlighted an optical field of approximately 12×12 mm coupled with a 20–40 MHz ultrasound band intended for superficial tissue imaging to an approximate depth around 10 mm. 

The HR (high-resolution) and HD (higher-depth) ultrasound modes were described as a way to emphasize either superficial layers or deeper structures within the skin and subcutis, depending on the clinical question. A battery-free design, powered by its controller, and a distilled-water coupling chamber were presented as choices intended to streamline day-to-day handling and acoustic transmission.

According to the training conducted by Dr. Gergely Csány, the concept is designed to support reproducible positioning, cloud-based review, and distributed collaboration. The software architecture was described as enabling capture at the bedside with later review on larger screens, potentially supporting consultation between different locations. The reviewers understood these elements as design intentions and not assurances of clinical advantage.

 Section I

OBSERVATIONAL IMPRESSIONS FROM A SONOLOGIST’S LENS
By: Dr. Robert L. Bard

With decades of experience in high-frequency ultrasound for oncologic and inflammatory skin evaluation, Dr. Robert L. Bard focused primarily on the workflow idea behind the dual-view. Historically, he explained, dermoscopy and ultrasound have existed as separate steps—often in different rooms—forcing a shift in attention, positioning, and context. He characterized the SkinScanner concept as 'an interesting approach intended to reduce that separation.

“Dermatology often emphasizes the surface, while radiology examines the layers underneath. In my view, the concept behind this device seems aimed at bringing those vantage points closer together!,” Dr. Bard noted.

During the session, he reviewed melanoma surveillance scenarios, scar and fibrosis monitoring, filler-related questions, and foreign-body detection in a general sense. He stated that, in principle, consistent probe alignment and an on-screen reference line may help an examiner revisit the same location later with comparable geometry. He described this as a potential workflow support, not a validation of accuracy or reliability.

Regarding patient communication, Dr. Bard observed that co-viewing a magnified surface image next to a subsurface ultrasound frame may make it easier to explain why a lesion is being monitored or why a follow-up is suggested. He emphasized that such an effect is about communication and context, not about diagnostic certainty: “When patients see a surface picture beside a corresponding ultrasound slice, they may better understand what we’re watching and why. That clarity can be helpful in discussion.... this is an advantage to imaging not seen anywhere else!”

On the topic of Doppler, which was described at an early, research-oriented stage, he stated that vascular information can be informative in general imaging practice and that the feature’s technical maturation and clinical evaluation would be necessary before forming conclusions. For this reason, Dr. Bard supports the inclusion and performance of Doppler blood flow imaging in this model as part of routine use.

Finally, from a sonologist’s standpoint, Dr. Bard supports the design concept of the Dermus in a single session that might maintain continuity between surface clues and subdermal context. “In my view, the repeatability and real-time nature of ultrasound may support closer monitoring... the movement to ‘go digital’ also brings significant advantages between clinicians in different locations by allowing them to share patient scans and test images in real time.”

Dr. Bard's Objectives: Inflammation, Scars, and Foreign Bodies

Beyond oncology, Bard sees powerful value in inflammatory and traumatic conditions. He routinely evaluates:

• dermal fibrosis and scar progression

• post-surgical or post-radiation changes

• foreign body reactions

• nodules from fillers or environmental exposure

• micro-calcifications at early formation

He describes one of his early test cases where a benign-appearing scar revealed deep-layer fibrosis and edema that would have otherwise gone untreated: “On the surface, it was flat. Classic scar. But the ultrasound layer showed a trapped pocket of inflammatory fluid strangling the microvasculature. Because we saw it, we treated it. That’s the kind of win patients will never forget.”

A Tool That Elevates Patient Education

Dr. Bard is also vocal about what he calls “visual medicine for the modern patient.” Today’s patients do not respond to vague explanations—they respond to clarity. “A patient will never forget the moment you show them their own cancer forming, or their own tissue healing. When they see it with their own eyes, compliance becomes a partnership instead of a persuasion.” The dual-display feature, he says, gives patients context—the single most underrated element in patient communication.

Why Dr. Bard Believes This Device Matters

Dr. Bard identified several strategic aspects of the SkinScanner concept that, in his view, illustrate its potential value in dermatologic imaging. He noted its emphasis on continuity, observing that the design is intended to minimize disruption between surface and subsurface evaluation. He also cited reproducibility as a strength, as its alignment features appeared to support consistent follow-up imaging over time. The system’s portability, allowing the scanner to be brought directly to the patient, was viewed as a practical advantage for workflow efficiency. Dr. Bard further remarked on the concept’s focus on transparency, suggesting that when patients can observe the imaging process, they may better understand and feel more at ease with their care. Finally, he described early detection as a guiding principle behind this type of technology—an approach that aims to make smaller, earlier tissue changes more readily observable for study and discussion.

He summarizes it this way: “This device is not replacing ultrasound. It is not replacing dermoscopy. It is making both smarter, and bringing them directly to the front lines. That is why I believe in it.”

Looking Ahead

Dr. Bard is especially interested in the SkinScanner’s future Doppler potential, particularly for inflammatory skin disease, tumor vascularity, and perfusion studies. In his view, structural imaging without vascular context is “a two-dimensional truth.” Add Doppler, and the disease’s behavior becomes visible—not just its shape.

 Section II

DR. ABDEL ZERZIF ON ENVIRONMENTAL AND OCCUPATIONAL DERMATOLOGY CONTEXT

Abdel Zerzif, practicing dermatologist in Morocco, discussed the realities of exposure-driven dermatoses among workers in agriculture, textiles, mining, construction, and related industries. He emphasized that many exposure conditions present with mild or ambiguous surface appearances while deeper inflammatory processes continue underneath.

“In my experience, the more challenging exposure cases do not always reveal their full extent on the surface. The dual-layer concept—surface and subsurface side-by-side... shows to address this problem,”.

He outlined common diagnostic pitfalls that, in his view, the dual-view approach might help contextualize:

• Benign-appearing rashes with significant deeper activity: Without subsurface context, such cases may be underestimated. A paired view could help visualize edema patterns or fibrotic changes under apparently stable surfaces.

• Chronic contact dermatitis: Some cases appear to quiet at the epidermis while deeper tissue remains involved; a subsurface image may help illustrate persistence or distribution.

• Granulomatous reactions: These are sometimes visually subtle and temporally variable; cross-sectional imaging might offer an impression of depth and density to guide discussion.

He added that portability is relevant in regions where imaging infrastructure is scarce and travel is costly or impractical. From a public-health perspective, a handheld, dual-modality concept that is intended to move between settings could support same-visit documentation and longitudinal comparisons. He repeatedly clarified that these points are hypothetical advantages and do not constitute clinical claims.

Zerzif also touched on the psychological dimension of exposure dermatology. Patients experiencing chronic symptoms with minimal surface findings often feel dismissed. He stated that even a non-conclusive subsurface visualization used for explanation may help patients feel that their concerns are being approached methodically. In his words: “When I can show a patient how we are framing both what we see and what might be occurring underneath, it sometimes improves the conversation. That is an advantage in communication of what supports diagnostic care in real time!”

For follow-up, Dr. Zerzif viewed cloud archiving and repeatable positioning as administratively useful features that, if implemented carefully, could support time-based documentation—especially in longer courses of contact dermatitis or scarring patterns. 

 Section III

Dr. Leslie Valle-Montoya on Trauma, Fire Service, and Remote Collaboration

Dr. Leslie Valle-Montoya, an integrative physician and former EMT-paramedic working closely with firefighters and toxic-exposure cases, discussed the mismatch she often encounters between surface appearance and deeper tissue response. In her perspective, burns, chemical exposures, and chronic irritant contact patterns can appear contained externally while progressing internally.

“In emergency work we frequently treated what we could see. The deeper story was typically unavailable at the bedside,” she said. “The dual-view concept interests me because it might offer a structured way to present surface and subsurface context together...”

Valle-Montoya also focused on distributed care. During the demo, she tested cloud sharing and described it as a potential mechanism for outside review in geographies without on-site subspecialists. She framed this as workflow curiosity—a way to move images for a timely opinion when a specialty clinic is not immediately available.

For firefighter follow-up, she highlighted reproducible positioning and archival review as organizational advantages that might assist with exposure timelines and documentation of inflammatory trajectories. She stressed that these are administrative and educational points, not statements about diagnostic performance. Valle-Montoya also discussed EMS protocols more broadly. She suggested that tools oriented around bedside visualization—even at a conceptual level—could help frame triage discussions or early decisions when dealing with suspected chemical contact or thermal injury. 

 Section IV

TRAINING, HANDLING, AND PRACTICAL NOTES (as Demonstrated)

The training session, led by Dr. Gergely Csány, emphasized:

• Consistent probe placement and a positional reference intended to help the operator revisit the same area on subsequent scans.

• Use of distilled or demineralized water in the coupling chamber to support acoustic transmission and mitigate unwanted residues.

• Controller-powered operation aimed at minimizing weight and eliminating charge management.

• App-level capture and cloud review, presented as a way to separate bedside scanning from later analysis in a quieter setting.

All four points were received by reviewers as practical design intentions. The reviewers stated that the value of these choices would depend on operator technique, case selection, environment, and future evaluation.

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Section V

HYPOTHETICAL USE-CASE FRAMES  

To clarify why the concept drew significant attention to the Bard team, the reviewers offered frames that called for exploration in formal studies. 

1. Melanoma surveillance context: A side-by-side surface and subsurface view might help an examiner return to the same region for visual comparison, including discussion with the patient about stable vs. changing patterns. Any clinical conclusions would require separate, rigorous validation.

2. Inflammatory dermatoses: In chronic cases where the epidermis appears quiet while the patient reports symptoms, a subsurface image could offer discussion material around edema distribution or fibrotic elements—again, purely as context, not as proof.

3. Scar and fibrosis monitoring: A reproducible cross-section might support conversations about remodeling over time. This is an informational use-frame rather than a diagnostic claim.

4. Occupational and exposure follow-up: For firefighters or industrial workers, an archive of serial images could help track a complaint over months, especially in administrative or occupational-health settings where documentation is important. Whether this changes outcomes is undetermined and outside the scope of the demo.

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Section VI

AREAS OF INTEREST

The reviewers collectively described several areas of interest that might warrant study:

• Position reproducibility and inter-operator consistency
• Image quality management across different skin types and anatomical sites
• Integration protocols for clinics that already separate dermoscopy and ultrasound
• Training pathways to support safe and consistent use
• Data handling for cloud review, including privacy and consent workflows

 

Patient Communication and Ethical Framing

All three reviewers commented that a paired view (surface alongside subsurface) may promote clearer communication. Patients often want to know why something is being observed rather than immediately removed, or why a follow-up is scheduled. In such conversations, a dual view could help set expectations and reduce speculation. At the same time, the reviewers emphasized that any such use should be accompanied by transparent disclaimers: the image is a visual tool and not proof of diagnosis.

The ethical framing suggested by the reviewers is straightforward: present what was observed in the demo as observation, outline what is not known, and avoid making promissory statements. In any written or verbal explanation, it may be helpful to explicitly state that this approach is concept-driven and under active evaluation, not a settled standard.

Final Statements:

• "SkinScanner—a groundbreaking concept innovating what could be the next-gen of portable imaging." 

• "...this portable, handheld device offers high-resolution ultrasound imaging to the realm of evidence-based skin treatments,"

• "From the outset, this device captured my attention—not merely as a piece of hardware, but as a conceptual leap forward for diagnostic imaging."

• "In our diagnostic center—equipped with hospital-grade ultrasound systems—the freedom to move the scanner from room to room has reduced workflow disruptions, particularly during multi-technology exams involving ultrasound and thermography. Instead of transporting patients between stations, we bring the technology to them, preserving continuity and minimizing discomfort." 

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Conclusion 

In summary, the HealthTech Review team expressed optimism about the dual-modality concept, noting that its design appears thoughtfully oriented toward unifying surface and subsurface visualization within a single session. The combination of portability, side-by-side comparative viewing, controller-powered mobility, and cloud-based review was seen as a forward-thinking approach that may help streamline communication, support positioning consistency, and encourage collaboration across locations. While their impressions were based on a limited demonstration rather than clinical performance, the group viewed the concept as a meaningful and inspiring direction for continued development in imaging-assisted dermatology.

Disclaimer:  No statement in this report should be interpreted as a claim of diagnostic capability, a guarantee of outcomes, or a prediction about clinical impact. Any real-world role the concept may eventually play will depend on responsible testing, formal validation, operator training, and case-appropriate use.  

 

Dr. Mazza is Illuminating the Future of Thyroid Care with PBMT

Photobiomodulation as the First Disease-Modifying Therapy for Hashimoto Thyroiditis

By Dr. Angela Mazza, DO, ABAARM, FAAMFM, ECNU, CDE

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Special thanks to Aspen Laser

Introduction: A New Horizon in Autoimmune Thyroid Disease

Hashimoto thyroiditis (HT) is the most common autoimmune endocrine disorder in the world—and one of the most frustrating for patients and clinicians alike. Affecting an estimated 14–20 million Americans, Hashimoto’s gradually destroys thyroid tissue through chronic lymphocytic inflammation, oxidative stress, and progressive fibrosis. For decades, the medical community has approached this condition with one main tool: thyroid hormone replacement. While levothyroxine effectively normalizes laboratory values, it does nothing to halt the autoimmune attack, restore thyroid structure, reduce antibody burden, or improve tissue health.

This leaves millions of patients symptomatic and discouraged, even when their labs read as “normal.” Fatigue, brain fog, weight changes, cold intolerance, mood disturbances, and metabolic dysfunction persist in up to 40% of individuals despite appropriate thyroid hormone dosing. The discrepancy between biochemical euthyroidism and ongoing clinical suffering highlights a central truth: Hashimoto’s is not merely a hormone deficiency—it is a progressive autoimmune and tissue disease.

Dr. Angela Mazza, a nationally recognized integrative endocrinologist, believes it is time to elevate thyroid care beyond hormone replacement and into the era of true disease modification. Based on her experience, advanced imaging collaborations, and deep understanding of endocrine immunology, she proposes a bold scientific direction: Photobiomodulation (red and near-infrared light therapy) may be the first realistic, non-pharmacologic therapy capable of modifying the course of Hashimoto thyroiditis at its root.

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The Science Behind Near Infrared Laser Therapy:

Why Red Light Has a Unique Role in Thyroid Health**

Photobiomodulation (PBMT), including red and near-infrared (NIR) light therapy, uses specific wavelengths (typically 600–1100 nm) to stimulate cellular repair, reduce inflammation, and restore physiologic function. Unlike ablative lasers or heating devices, PBMT works at low power densities, initiating photochemical—not thermal—reactions within cells.

The thyroid gland is uniquely suited to benefit from PBMT for several reasons:

1. High Mitochondrial Density

Thyroid follicular cells are among the most metabolically active cells in the body. PBMT directly stimulates cytochrome c oxidase within mitochondria, leading to:

·   Increased ATP production

·   Enhanced cellular energy metabolism

·   Improved oxygen use

·   Restoration of injured or dysfunctional cells

A gland dependent on mitochondrial-driven hormone synthesis is ideally positioned to respond positively to PBMT.

 

2. Reduction of Oxidative Stress

Hashimoto’s is characterized by heightened oxidative stress—partly because the thyroid uses hydrogen peroxide (H₂O₂) to create hormones, and partly because autoimmune inflammation generates excess reactive oxygen species (ROS).

PBMT has been shown to:

·   Lower ROS production

·   Activate the body’s natural antioxidant enzymes

·   Reduce oxidative injury within thyroid tissue

This helps protect thyroid follicles from continued immune-mediated destruction.

 

3. Immune Modulation

Hashimoto’s involves an overactivation of Th1 and Th17 immune pathways and impaired T-regulatory (Treg) function. PBMT has demonstrated:

·   Downregulation of NF-κB (a major inflammatory switch)

·   Reduction of pro-inflammatory cytokines (IL-6, TNF-α, IL-1β)

·   Increased Treg activity and improved immune tolerance

·   Shift from M1 to M2 macrophages, promoting resolution instead of damage

This is precisely the type of immune correction needed in HT.

 

4. Improved Microcirculation

Lack of microvascular flow contributes to tissue inflammation and impaired healing. PBMT stimulates nitric oxide release and angiogenesis, improving perfusion and allowing nutrients, oxygen, and immune-calming factors to reach damaged tissue.

 

5. Potential Reversal of Fibrosis

Long-standing Hashimoto’s causes fibrosis and architectural distortion visible on ultrasound. PBMT has shown the ability to regulate collagen turnover, reduce fibroblast overactivity, and promote structural recovery—an unprecedented outcome in thyroid disease.

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Evidence Supporting PBMT in Hashimoto’s

Although relatively new in thyroid medicine, PBMT already has promising published evidence:

·  A 2010 pilot study showed improved thyroid echogenicity, reduced antibodies, and measurable improvements on ultrasound.

·  A 2013 randomized, placebo-controlled trial demonstrated improved thyroid function and reduced levothyroxine requirements in a significant portion of treated participants.

·  A 2018 longitudinal study found sustained benefits up to 6 years post-treatment, including improved thyroid architecture and, in some cases, maintained euthyroidism without medication.

·  A 2022 systematic review concluded that PBMT is safe, biologically plausible, and shows consistent signals of benefit—yet emphasized the need for larger, properly designed clinical trials.

While early-stage, these findings support Dr. Mazza’s premise that PBMT may be the first intervention capable of altering the natural history of Hashimoto thyroiditis.

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Why Current Thyroid Care Is Not Enough

The standard treatment approach—monitoring labs and adjusting medication—fails to address:

·  Ongoing autoimmune destruction

·  Tissue-level inflammation and fibrosis

·  Vascular stagnation

·  Mitochondrial dysfunction

·  Antibody persistence

Adjunctive interventions such as selenium, myo-inositol, dietary changes, or low-dose naltrexone can provide incremental support but do not stop or reverse disease progression. The result is a clinical gap: patients remain symptomatic because the underlying disease remains unaddressed.

PBMT may finally offer a tool to intervene where endocrine medicine has historically been unable to act.

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Dr. Mazza’s Vision: A Disease-Modifying Future for Thyroid Care

Dr. Mazza proposes a groundbreaking clinical trial that integrates:

·        Red/NIR photobiomodulation

·        High-resolution ultrasound

·        Elastography for fibrosis analysis

·        Vascular Doppler assessment

·        Thyroid antibodies and hormone panels

·        Clinical symptom scoring

This holistic, multimodal assessment merges endocrine science with state-of-the-art imaging to evaluate PBMT’s capacity to restore thyroid health—not just manage symptoms.

Her vision is clear:

“Hashimoto’s has never had a true disease-modifying therapy. Photobiomodulation may be the first treatment capable of changing the trajectory of thyroid autoimmunity.”

This study aims to produce the most comprehensive thyroid PBMT dataset ever generated in the U.S., offering device manufacturers a unique opportunity to align their technology with a potentially revolutionary medical advancement.

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Advantages for PBMT Developers

Manufacturers stand to gain:

1. Clinical Validation for Expanded Indications

A successful trial supports FDA considerations, clinical claims, and broader adoption.

2. Entry Into a Multi-Million-Patient Market

Thyroid disease affects 1 in 8 women and is one of the most undertreated autoimmune disorders.

3. Differentiation in a Competitive PBMT Industry

Being the first device validated for autoimmune thyroiditis establishes unmatched market leadership.

4. High-Visibility Clinical Exposure

Results will be shared through medical conferences, scientific publications, and national education initiatives.

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Conclusion: Lighting the Path to a New Standard of Care

Hashimoto thyroiditis has remained a clinical paradox: highly prevalent, deeply impactful, yet medically underserved. Hormone replacement manages symptoms, but does not change the underlying autoimmune disease. With photobiomodulation, Dr. Mazza sees the possibility of a true shift—a therapy that addresses mitochondrial health, inflammation, microcirculation, oxidative stress, and tissue integrity all at once.

This theory is grounded in strong scientific rationale, supported by emerging evidence, and guided by clinical experience. If validated, PBMT could become the first-ever treatment capable of modifying the course of Hashimoto thyroiditis.

For device innovators and PBMT manufacturers, this is not just an opportunity—it is a chance to participate in a transformative movement in thyroid medicine.
The light that photobiomodulation delivers may very well become the light that leads millions of patients to lasting, meaningful healing.

 

 P A R T   2

THE EYE WITHIN UNLOCKING THE HIDDEN LANGUAGE OF MEDICAL IMAGING By: Lennard M. Goetze, Ed.D   In an age when medical imaging technologies grow more advanced by the day, one truth remains unchanged: a scan is only as valuable as the mind interpreting it. The Eye Within pulls back the curtain on the art and science of diagnostic interpretation through the career and insights of Dr. Robert Bard—internationally recognized cancer imaging specialist, educator, and pioneer in ultrasound diagnostics. This is not a book about machines; it is about mastery. Dr. Bard takes readers into the high-stakes environment of medical imaging, where detecting a shadow, reading a flow pattern, or recognizing a subtle shift in tissue texture can change a life. With clarity and precision, he explains how ultrasound—when wielded by an experienced interpreter—becomes more than a tool for capturing anatomy. It becomes a dynamic instrument for understanding disease behavior, predicting progression, and guiding treatment. From evaluating elusive thyroid disorders to identifying aggressive cancers others might miss, Dr. Bard demonstrates the power of seeing beyond the image. His work exemplifies how structural detail, physiologic clues, and contextual patient information combine into a complete diagnostic picture. At its heart, The Eye Within is both an education and a call to action—urging the medical community to value interpretation as a central pillar of care. For clinicians, students, and health advocates, it is a masterclass in precision medicine. For patients, it is reassurance that in the right hands, every image tells a story—and the right interpreter knows exactly how to read it.    Copyright © 2025- Hummingbird Medical Press / Lennard Goetze Publications. All rights reserved.

READING BETWEEN THE ECHOES

Dr. Bard Reviews Dr. Mazza's Thyroid Ultrasound Scans

 

Introduction – The Eye That Reads Beyond the Image

In the evolving landscape of diagnostic imaging, technology has made breathtaking advances. Yet, as Dr. Robert Bard often reminds all his colleagues, “It’s not the probe, but the interpreter, that saves the patient.”

Ultrasound has become a preferred frontline tool for thyroid evaluation, particularly for identifying nodules, monitoring autoimmune conditions like Hashimoto’s disease, and managing hyperactive disorders such as Graves disease. But while many can operate the machine, very few can translate its subtle, often cryptic language into decisive clinical insight. Dr. Bard is one of those few—a master “ultrasound translator” who sees patterns, behaviors, and evolving risks invisible to most.

This observational session—built on a series of ten thyroid ultrasound slides provided by Dr. Angela Mazza—offers a rare glimpse into the process of real-time interpretation. Six images focus on thyroid nodules; the remaining highlight hallmark features of Hashimoto’s thyroiditis and Graves disease. As Dr. Bard examines each slide, he performs not merely an identification exercise, but an on-time analysis: assessing the surrounding anatomy, interpreting vascular and tissue signatures, and predicting potential outcomes.

Even in an era of AI-assisted imaging, this skill remains irreplaceable. Artificial intelligence can catalog shapes and colors, but it cannot yet replicate the human ability to weigh anatomical nuance, integrate patient history, evaluate the tumor’s ecosystem, and make forward-looking predictions. Interpretation—true interpretation—blends technology, clinical reasoning, and physiological understanding.

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Dr. Angela Mazza introduces her scans of a patient, touring us into the THYROIDSCAN process. Below are are Dr. Bard’s own notes, presented in the first person, refined for clarity and depth, reflecting his approach as both a diagnostician and educator.

Assessment 1: NODULES

 

Click to enlarge

Solid Growth Without Suspicious Calcifications

I begin with the skin layer clearly visible at the top, followed by the anterior neck musculature and, deeper, the thyroid itself. The lesion’s borders are smooth—always a favorable sign—and I see no suspicious microcalcifications. While microcalcifications are nonspecific, their presence can indicate tissue degeneration from rapid tumor growth and poor vascular supply. Here, the echo pattern is heterogeneous, meaning the texture varies within the nodule, which warrants closer review. Of particular academic interest is the posterior wall brightness—dimmer than the anterior—reflecting sound absorption by solid tissue. This “through transmission” loss can signal dense or heterogeneous pathology and is an important interpretive clue.

 

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Simple Cyst with High Through Transmission

This image shows a well-circumscribed, cystic structure. The posterior border is brighter than the anterior because fluid allows sound to pass freely. Internal debris is visible—common in benign cysts and observable with high-resolution probes. Surrounding tissues are neither compressed nor invaded, suggesting no aggressive behavior. This is a prime example of strong through transmission, a useful differentiator between cystic and solid pathology.

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Partially Cystic Complex Nodule
This lesion exhibits both solid and cystic components, the most common benign thyroid pattern but also possible in malignancies. The posterior border is again brighter due to the fluid component. On the left, I note the common carotid artery—its wall smooth and without plaque. When scanning thyroids, I always evaluate adjacent structures; lymph nodes and vessels often provide indirect clues to pathology.

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Predominantly Solid Complex Nodule with Early Calcification

Here, the anterior and posterior borders are similar in brightness, suggesting limited fluid content. The heterogeneous echo texture and a small calcification at the cystic-solid interface may represent tumor degeneration. It’s important to remember that tumor enlargement during therapy does not always indicate progression—degenerating tumors can swell with fluid before shrinking.

 

 

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Septated Complex Nodule with Macrocalcification

The lesion contains cystic and solid areas separated by septations, giving it a spongiform appearance. The macrocalcification is consistent with degenerative change. The bright posterior border confirms significant cystic degeneration—what I refer to as “internal cystic necrosis”—often a sign of tumor breakdown.

 

Assessment #2:  THYROID CANCER    

 

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Classic Ultrasound Signatures of Thyroid Cancer

In this case, credit must be given to Dr. Angela Mazza for her precise capture of a lesion demonstrating classic hallmarks of thyroid cancer. High-quality image acquisition is not accidental—it reflects an operator’s ability to optimize probe selection, angulation, and focal depth to reveal the lesion’s most telling features. This provides the interpreting radiologist with the complete visual data needed for an accurate assessment. One such feature is the presence of microcalcifications—tiny, punctate echogenic foci within the lesion. While not exclusively diagnostic of cancer, their occurrence often signals abnormal cellular turnover and tissue degeneration, making them an important red flag in the radiologist’s assessment.

A second hallmark is the firm, rigid texture of malignant tissue. I often describe it to students using the “steel analogy”: just as steel resists penetration, cancerous tissue offers a gritty, unyielding resistance to a biopsy needle. This hardness correlates with the tumor’s dense cellular structure and fibrotic reaction. Equally significant is the taller-than-wide dimension ratio. Benign nodules, when they grow, tend to expand laterally, developing smooth, encapsulated borders. Aggressive cancers, however, often invade vertically, crossing tissue planes. This vertical dominance is a subtle but critical diagnostic cue—used not only in thyroid cancer but also in breast oncology.

On ultrasound, malignancies typically appear hypoechoic—darker than the surrounding thyroid parenchyma—because the dense cellular mass absorbs more sound energy, allowing less to be reflected back to the transducer. This also results in a posterior acoustic shadow or a dimmer back border, further reinforcing the suspicion of a solid, infiltrative process. When these elements—microcalcifications, firmness, hypoechogenicity, vertical growth, and diminished posterior transmission—are observed together, they form a constellation of findings that strongly favor malignancy. The role of the interpreting radiologist is not simply t note these features, but to integrate them into a complete risk profile for each patient, guiding both urgency and strategy in clinical management.

 

Assessment 3: HASHIMOTO’S & GRAVES DISEASE

 

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Hashimoto’s Thyroiditis

Hashimoto’s presents variably on ultrasound—sometimes uniform in echotexture, sometimes showing fibrotic stranding and mixed internal patterns. Routine thyroid blood panels can miss autoimmune-mediated inflammation, making ultrasound a critical adjunct. The gland may reveal fibrotic bands, patchy echogenic change, or small cystic areas depending on the stage of degeneration. In this case, the echo pattern is mixed, with no significant change in rear-wall brightness compared to normal thyroid tissue. Because through-transmission may remain unaltered, interpretation must be integrated with autoimmune-specific serology, patient symptoms, and disease history to achieve a confident diagnosis and guide long-term management.

 

 

Graves

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Disease: Baseline B-Mode & with Color Doppler

Although Graves’ disease is not a form of cancer, it remains a significant thyroid condition because of its system-wide effects and marked increase in glandular blood flow. The overproduction of thyroid hormones accelerates metabolism across multiple organ systems, influencing cardiovascular function, skin changes, and general physiological balance. In grayscale (B-mode) ultrasound, the thyroid often presents with a uniform appearance, though areas of patchy irregularity from fibrotic change may be visible. Through-transmission typically mirrors that of normal tissue; however, the clearest diagnostic distinction emerges when color Doppler imaging is applied.

 

Under Doppler, Graves’ disease can display a pronounced surge in intrathyroidal vascularity, with smooth, branching blood vessels feeding an overactive gland. This striking visual signature—sometimes described as a “thyroid inferno”—serves not only as an identifier of disease activity but also as a guide for therapy. By following these vascular patterns over time, clinicians can fine-tune treatment plans and adjust dosages without invasive biopsies or radioactive scans.

 

 

THERMOLOGY: THE STRATEGIC FIRST STEP IN THYROID IMAGING

Before an ultrasound probe touches the skin, thermographic imaging can create a dynamic map of the thyroid’s physiologic activity. By detecting infrared heat patterns from the skin surface, thermology reveals areas of abnormal vascular activity—whether from inflammation, autoimmune flare, or tumor-driven angiogenesis. This non-contact, radiation-free technique serves as an early “scout,” directing the sonographer’s focus to regions most likely to harbor disease.

 

When paired with ultrasound, thermology’s surface heat mapping complements sonography’s deeper structural view. Elevated heat zones may correspond to hypervascular nodules in Graves’ disease or inflammatory patterns in Hashimoto’s, while cooler areas may signal cystic or fibrotic changes. Beyond detection, thermal assessment can monitor treatment response—declines in both vascularity and gland temperature often indicate therapy is working. 

In skilled hands, this dual-modality approach—thermology for physiologic mapping and ultrasound for structural definition—offers a fast, noninvasive, and highly precise pathway for diagnosis, monitoring, and personalized thyroid care.

 

CONCLUSION – A PARTNERSHIP IN PRECISION

Dr. Bard’s review of Dr. Angela Mazza’s thyroid ultrasound cases demonstrates why expertise in interpretation remains indispensable. Every scan is more than an image—it is a layered narrative of structure, function, and evolving physiology. By coupling her deep endocrinology expertise with ultrasound as a primary diagnostic tool, Dr. Mazza ensures her patients receive assessments that are both scientifically rigorous and dynamically responsive.

In an age where algorithms threaten to overshadow human judgment, this collaboration underscores an enduring truth: the best outcomes emerge when skilled imaging interpretation meets the informed clinical context of a specialist who understands the whole patient.

 

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