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Feb 18
2010
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Do you do Level 5 sonography?Posted by: Prashant Bhatt on Feb 18, 2010  |
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Do you do Level 5 sonography?
Society can be analyzed in different ways. One of the ways to do that is to see how technology has affected the ways of living.
Levels
In an Editorial written in 1989, Dr. Roy A. Filly told about Level 5 Ultrasound. (1) He wrote about a call from a clinician asking whether he performed Level 4 Ultrasound. He had never heard of Level 4 sonography, but the request itself struck an unusual chord within him. He recognized this request itself as part of a growing problem in obstetric sonography. Uncharacteristically for him, he shot back
“I only perform Level 5 sonography”.
Rather than chastise him for this cavalier statement, the clinician thanked him and the patient dutifully reported the next day with a request for a Level 5 Sonogram.
In some IRADIX interacts –readers have said that the problem of regulation of Imaging equipment is unique to India where norms are not followed. This is not true.
The Editorial clearly talks about this issue in an advanced country and goes on to state
These untrained physicians have latched onto the phrase “Level 1 examiners” as though it were a cloak of protection for their lack of knowledge. Any longer, when I am consulted by a physician who begins the conversation by stating “ I only do Level 1 sonography” or “I can only do Level 1 sonography on my machine” the conversation usually quickly confirms that the physician, in practice, does not do “sonography” at all; he or she simply bills for sonograms after waving “the magic transducer” over the mother’s abdomen and entertaining her for a while. (Ref 1)
How do you plough your fields?
“Why should I get a scan and register my wife for antenatal care” one rustic villager asked.
“My mother had six children, all healthy, and she never went to a gynecologist” he continued.
The surgeon , who was just starting his set-up, and making ends meet against great odds asked the man how he went to Rewari.
“By bus, of course” he answered, a bit surprised at this foolish question from an educated doctor. “I am going to buy a Maruti car soon” he added.
“But your grandfather used the bullock cart to go to Rewari” the doctor now revealed the purpose of his initial “foolish” question.
With the spread of technology and mechanization, first in the factories and then in agriculture, many new possibilities opened up.
“How do you plough your fields” the doctor further ploughed the mind of this questioning client.
Technology and Influences: A need to look beyond
In one of his interact-comments Dr.Virupaksha Joshi summarized the dilemmas facing the field very well- http://www.iradix.in/494-Medicine-as-a-Profession...-Business...or-Both.html#comment-989
Therefore, if a system needs an overhaul, one should begin with the individual. That means you and I have to change first. If individuals feel helpless and trapped within a corrupt system, some kind of legislation or governance or judicial intervention is called for. Like how it happened with sex determination fiasco and PNDT. That means someone outside the medical establishment will dictate the terms. We should not complain if that happens because we asked for it. We get what we deserve.
The community was/is not able to give a coherent reply due to issues of legalism, analysis-paralysis, lack of history of being the agitating professions (like students, lawyers)..(For a more detailed narrative see blogs:
http://www.iradix.in/357-What-is-Appropriate-Authority.html,
http://www.iradix.in/358-Is-there-reason-to-be-scared.html
If we do not look beyond the surface level can we hold our ground?
A technology driven field like Radiology has become more important in the past few decades. With this the other forces in society have merged to evolve new realities. Urbanization. Finance. Shift of population from Rural to urban and semi-urban settings.
Most developing societies which formed Nation states around the mid 20th century see these changes of industrialization, urbanization, democratization/dictatorial putsches, increasing disposable incomes at a pace which is much more rapid and simultaneous than it took place in more advanced parts of the world, where they first had the formation of the nation state, then industrialization, then Urbanization and finally democratization.
Technological revolutions have overlapped. Also when these countries which are advanced now were going through these stages, there were no dominant powers or finance capital which would shape the world, choices and systems.
If one sees the way diagnostic centres and private health care systems have developed in India as an example one can see the different layers, and hence find where we fit in regarding dilemmas shaped by the choices of the system, whether it is Cut practice Moral crossroads or PNDT regulatory corrupt degeneration.
“What did you do regarding PNDT” a radiologist asked the CEO of a big hospital.
“We just gave them one lump-sum for all the registrations” the CEO said in a hushed tone. “They will not come anywhere near.”
In that moment, the radiologist recalled the struggles of some of his friends running more humble set-ups and remembered the sage words of an experienced physician who told that it is becoming more and more difficult for smaller set-ups to break even, with increasing regulatory and legal-insurance issues coming in. Hence we have to shape our practice in relation to the big set-ups which are providing similar services at similar costs.
Property has been transformed and more and more property is industrial-manifest in the factories, business houses, and workshops-and also the nature of property has changed. There is uneven development in developing societies. Earlier concrete possessions such as land and money are being converted to more intangible kinds of property such as shares of stock, negotiable equities of all kinds, and bonds which are assuming greater influences in society.
How does this shape our world? The equipments are supplied by leading transnationals who have their local service and marketing units.
Even if you say that you have a set-up of your own, and will run it as you want, you should be clear that if you do not play the game according to the ground rules, the mortgage on your equipments and real-estate is always with the financial institutions.
The keys of your car-house may also land up in their safe if you fail to pay up.
“How do your plough your fields” the question of the surgeon friend came back to the radiologist.
A few years down the line, when he visited him, the Surgeon now had his own Radiology equipment which he and his wife (‘leading’ Gynecologist) are ploughing on their own….doing Level 1 sonography.
“Do you see the hands when doing obstetric sonography?”
“We perform Level 1 sonography” the surgeon replied.
“Is there anything known as Level 1 Surgery”…the radiologist wanted to ask, but held his tongue.
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Choices within systems.
Whether you call it insight, choice, frustration or ‘running-away’ ..but the mindset and logic of this level of medical care and practice and where it would lead was clear to the radiologist ….so ..in a few years, he shifted to a better more professional level of Medical care. Which level of sonography did you do or review today?
Notes and suggested further reading:
- Filly RA; Level 1,Level 2,Level 3 Obstetric Sonography: I’ll see your level and Raise you One. Radiology 1989;172:312
- <2i>Obstetric US: Watch the Fetal Hands by Francoise Rypens, Josee Dubois, Laurant Garel..Radiographics 2006;26:811-832.
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Reviewed by Dr. Sridhar V February 22, 2010
Reviewed by Deepak Goyal February 22, 2010
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Just wanted to take a second and thank you for your post. Very insightful.
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Alok Varshney
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... Aw Prashant, level 5 is so 20th century. I think by now we are somewhere around level 7 or 8  The issue of who controls the technology comes up very often, some eying their vested interest, some with legitimate concerns. Ultrasound has revolutionized the way medicine is practiced and has provided lifelong careers to many Radiologists around the world. But does it mean that only radiologists get to control it? Sure they are better trained, but does it need to be kept away from gynecologists and other clinicians when it can aid in their decision making? We may think and demand that it should be so, but unfortunately (or is it fortunately) rest of the world will not share our thinking and it is not going to happen. If Radiologists wish to retain their hold and call themselves experts, they have to raise their bar much above the common portable machine using clinician. Also we should publicize the advantages of an exam by an expert Radiologist. |
Prashant Bhatt
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... Many smiles at the 21st century radiology and Healthcare trends. The question which troubles my "20th century" mind.. (or even older probably as I keep referring to 18th century Enlightenment philosophers like Rousseau/Locke/Vito/Bacon and your favorite Adam Smith) is .. Should a patient be billed 2 (or even more )times for the same test? What if I was the patient or relative? Will the insurance company pay? There is no objection if someone is competent to do a procedure. I know a Pediatrician trained in Hungary who can do better Pediatric ultrasound than most General Radiologists (he has even written a book). But if someone is doing "Level 1 sonography" and charging..it is unfair. Is there something known as a a Level 1 ECG read? Or a Level 1 surgery? Or a Level 1 Endoscopy? Or a Level 1 Arthroscopy? ...Please enlighten us ..of current 21st century trends  |
Dr. Sridhar V
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... I agree with you Dr.Prashant Have a look at this interesting link, regarding the difference between what they call Ultrasound Radiologists from( what I call the crowd..cardiologist gynecs,obstetricians,gastros,trained ones) http://forums.obgyn.net/ultrasound/ULTRASOUND.9805/0057.html It talks of Many advantages for the patient when the Ultrasound Radiologist does the scan rather than someone from the crowd, most importantly it tells the cost benefit factor for the patient. There was an iradix forum topic about non radiologists doing sonography -- posted by Dr.Sameer Kakkar from Shimla 9 months ago. I feel the discussion is never ending. Simply accept the fact Radiologists are famous for losing the battles all the time. The only solution available is Radiologists poaching non radiology subjects. Let the never ending arguments for and against rest in peace |
Alok Varshney
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... From the ‘witch hunting’ to castism, the issue has always been of control, rather than of competence. If the issue is of competence, yes I would agree with you. Still the question is how does one gain competence? I believe it can be done only by training and then by practice. A person competent by training to do sonography still may not achieve a level of expertise which an expert sonologist (capable of evaluating fetal hands) has; even many trained radiologists will fail that test. Useful technology will always propagate; one will never be able to restrict its use. People using technology will be incompetent, competent or supercompetent, along Gaussian curve. And yes I can read a level I ECG, that is MBBS stuff. But if I can’t understand it, I send it to a cardiologist. This is the basic structure of medical practice- referral to a higher center/ more learned/ more competent person when it is beyond one’s current level of skills. I get no kick in doing a routine cardiac activity scan, I think I can leave it for a gynecologist to do it (and charge for it). But the day she can beat me in assessing fetal hands or heart, I will pack my bags or move on to other things. Till then she will have to send the patients to me; she has the fear of missing an anomaly, very much being reinforced by me. |
Prashant Bhatt
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... Thanks Dr.Sridhar for those links to the obgyn forum. Regarding "poaching": One can keep the books of different subjects in the department library and see how they are treating their cases. It helps maintain professionalism and they know that the scanner+mind both are working. Otherwise, patients come up with the remark.. "Scan and give the films fast, otherwise our Doctor will go away" Ref#Alok:I will try to see the Curve and see that the downslide (obvious for all those working in non-academic settings) is more gradual. |
Alok Varshney
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... And Radiologists are already 'poaching' other specialties. Every time a Radiologist puts up a lab. or collection center alongside his radiology practice, he is poaching on a Pathologist/ microbiologist/ Biochemist's specialty. Automation of lab tests and cheap technology has done the same to pathologists/ biochemists as cheap ultrasound machines have done to Ultrasonologists. Such is the way of the world.... |
Dr. Sridhar V
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... hey hey hey High time somebody clarifies meaning of 'Poaching'....I am not talking of animal poaching. What is the definition of 'Poaching' ? I thought ' poaching ' meant one has to literally do the job. That is if radiologist has to poach a laboratory ... he personally has to attend biochemistry tests,see the hematology slides under microscope etc. etc.... But I find that is not the case. Since he is a professional he is giving responsibility to some pathologist or microbiologist to do the job and running the center, and mind you for the benefit of the society ( famously known as all under one roof ). Where as when non radiologists do ultrasound ( be level 1 0r level 1000000000000000000000 )- it amounts to poaching. If a non radiologists employs a radiologist to do scanning...do you still call it poaching ?? It is Time for the intellectuals to step in and enhance the knowledge base of the lesser mortals like me. |
Prashant Bhatt
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... I think Dr.Sridhar has made a very valid point. It is this habit of Non-Radiologists becoming "experts" like the Please-Repeat X-ray or the High Resolution CT or the Snowstorm-Ironing-with-probe Hepatologist whom we are talking about Setting up the "under-the-one-roof" setup is something different..what do you say Alok.. Or are we playing the game by different rules One set for ourselves,and other set for others? |
Alok Varshney
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... When a radiologist sets up a lab. with in his practice premises, certain amount of poaching does occur. Most lab tests are done by automated or semi automated systems fairly accurately and with ease, so much so a technician can oversee them. And that’s what most radiologists do, employ a tech. Pathologists/ Biochemists come in the picture for heavy hitting, the complex tests/ cyto or histopathology or complex tests. So essentially a radiologist is letting his credentials on the lab test report to vouch for lab tests in absentia for a pathologist/ biochemist. Ask a pathologist and he/ she will also describe the nuances of even a simple lab test. This is pretty much like radiology. The availability and ease of interpretation of common radiology tests (x-rays or routine ultrasound) makes it seem easy for a non-radiologist to interpret them, when a radiologist can always find nuances. The difficult things do get referred to a Radiologist and that’s where a radiologist has to go, by choice or per-force. Technology and information spread, there is no stopping them; whether it is the convenience or money factor, overlap of specialities will occur. Much of early radiology work was done by non-radiologists, so to speak; and still is. It is not uncommon to find professors chairing the department positions for gynecology/radiology or orthopedics/ radiology in the West. By definition of ‘poaching’ they should not be doing that. But that’s not how the world works. In my view, if radiologists are serious about the poaching issue, they should either raise the standard of examinations beyond the grasp of a clinician; or make sure that the non-radiologist clinician is sufficiently scared to do the interpretations on his own by continuously highlighting their mistakes. And not be scared of loosing their referral base... |
Prashant Bhatt
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... Interesting comments Alok.But are we confusing two separate issues? One is the Business component of a set-up and another the professional component of specialized medical care. There are overlaps as in all specializations. |
Alok Varshney
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... Nowhere in the discussions I found a phrase- a non-radiologist should do ultrasound if he is competent. Most of the discussions are regarding why is he doing it? The confusion between business and profession will always remain. As I said earlier most of the time the issue is not of competence but of control. Thats the business part, not the professional part. If the issue is competence, I do agree with you ( again as I said earlier). |
Dr. Sridhar V
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... Competent non radiologist doing Ultrasound vs (Now I put it as) Professional Radiologists doing ultrasound...there is a sea of difference. It is not just picking up a calculus here and a cyst there.Doing Ultrasound is much more than what generally anybody thinks ( I mean non radiologist radiologists ) Competent non radiologist can do the ultrasound but remember his/her USG knowledge is limited field of his/her specialty unlike Radiologist who simply scores over because of his vast exposure to the various aspects of the problem and his extra ordinary knowledge in all the branches of Medicine is a boon. As Faye Laing, M.D., President of the Society of Radiologists in Ultrasound, and Associate Professor of Radiology at Harvard University puts it "Often clinicians will do studies geared to their specialties. They answer specific questions, but they may overlook something major,' adds Laing. "Is a urologist who is doing a kidney study likely to discover gall stones or a mass in the liver? The radiologist examines the entire abdomen because he or she has no vested interest in a particular organ." source: http://forums.obgyn.net/ultrasound/ULTRASOUND.9805/0057.html The above link tells the various disadvantage to the patient if the Ultrasound is done by a non radiologist. One should have patience to go through the above link. |
Dr. Sridhar V
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... Why the 'Knowledge competency' is always the loser when it has to face the 'Business competency' ? Why this story repeats centuries after centuries ?? |
Alok Varshney
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... Radiologists are better trained, objective, thorough and cost effective; is it a surprise that radiologists will proclaim such? In yellow pages one finds Radiologists somewhere between a Quack and Snake oil salesman, who also claim superiority of their product. But the important question is- does the rest of the world sees us in the same way? Does a clinician believe in this? Or is it just a spiel from a service vendor, self marketing his product? Does a Radiologist differentiate himself from rest of the crowd or publicize his benefits? The market is a harsh judge of these things. Pagers lost to cellphones, new technology replaces old ones and life goes on. |
Virupaksha Joshi
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... Any clinician(non-radiologist) who is a thorough professional will always be as good as a trained radiologist (if not better) in interpreting various imaging tests pertaining to his or her specialty. I know it hurts but a radiologist should accept this. An urologist will interpret a KUB radiograph/usg or a CT urogram as well as a radiologist not because he is a genius but simply because he is familiar with every tiny clinical tidbit about his patient. This urologist monitors his patient’s progress on a daily basis, does a cystoscopy if required, gets an isotope scan done and operates whenever the situation demands. Therefore, when he looks at an IVU, a KUB radiograph, or a USG, he knows exactly what to look for and where to look for. He is less likely to miss anything. Let me quote a real life incident. One of my radiology colleagues was reporting a MRI of brain with DWI. The only clinical information that was offered to him by an ‘ayurvedic houseman’ was that this patient had difficulty in speaking. But the fact was that he had multiple cranial nerve palsies involving 9th,10th and 12th nerves. The diagnosis of Wallenberg’s syndrome was written all over and very obvious to the neurologist. Poor radiologist meticulously saw all the pulse sequences including the DWI images. The MRI tech had not printed the very first DWI image at the skull base, which showed a lateral medullary infarct. That was the only image in the entire study that showed the pathology. This radiologist reported it as a normal MRI. The neurologist came fuming to the MRI suite and demanded that all DWI images to be shown. There it was – an acute, PICA territory infarct. The neurologist left the MRI suite with a wry smile on face and with a smug satisfaction for having humbled the radiologist. What will you make of it? Is the neurologist better than the radiologist is? Incidentally, this radiologist friend of mine is a gold medallist in MD exam. The neurologist straight away looked for the one image most likely to show the abnormality because he knew that this patient had multiple cranial nerve palsies. This does not necessarily show the radiologist in bad light because he was in fact participating in a ‘double blind’ trial as aptly pointed by one of the bloggers on Iradix. Moral of this story is that clinician has an inbuilt edge over the radiologist when it comes to interpreting the images because of the reasons mentioned above. That doe not mean that he should take over the radiology equipments and believe me; many do not intend to do so. They still depend on the radiologist. However, there are always shades of gray. Some amount of ‘poaching’ will always be there. Radiologist will do well to raise the bar of standard rather than whining about poaching. |
Prashant Bhatt
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... Thanks VJ Sir for putting things in perspective. Regarding PICA-See the Parasagittal sections as sometimes the techs (as in this case) miss out the lower axial cuts. The Sagittal images give the diagnosis even if the lower axial cuts are missed on filming. A question: Does having done a Housejob or Clinical rotation help/change the depth of reporting? |
Dr. Arvind Bhan
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... having done a housejob or having clinical experience does improve depth of reporting. |
Prashant Bhatt
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... Dear Arvind Thanks for the comments. Yes, doing a housejob does help and adds to insights. For those who have become older and cannot start doing house jobs again forming Special Interest groups helps See this blog www.iradix.in/506-I-initially-missed-out-on-this-case.html |
jessica forester
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... After 6 months of offering stem cell therapy in combination with the venous angioplasty liberation procedure, patients of CCSVI Clinic have reported excellent health outcomes. Ms. Kasma Gianopoulos of Athens Greece, who was diagnosed with the Relapsing/Remitting form of MS in 1997 called the combination of treatments a “cure”. “I feel I am completely cured” says Ms. Gianopoulos, “my symptoms have disappeared and I have a recovery of many functions, notably my balance and my muscle strength is all coming (back). Even after six months, I feel like there are good changes happening almost every day. Before, my biggest fear was that the changes wouldn’t (hold). I don’t even worry about having a relapse anymore. I’m looking forward to a normal life with my family. I think I would call that a miracle.” Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. www.youtube.com/watch?v=jFQr2eqm3Cg. Dr. Avneesh Gupte, the Neurosurgeon at Noble Hospital performing the procedure has been encouraged by results in Cerebral Palsy patients as well. “We are fortunate to be able to offer the treatment because not every hospital is able to perform these types of transplants. You must have the specialized medical equipment and specially trained doctors and nurses”. With regard to MS patients, “We are cautious, but nevertheless excited by what patients are telling us. Suffice to say that the few patients who have had the therapy through us are noticing recovery of neuro deficits beyond what the venous angioplasty only should account for”. Dr. Unmesh of Noble continues: “These are early days and certainly all evidence that the combination of liberation and stem cell therapies working together at this point is anecdotal. However I am not aware of other medical facilities in the world that offer the synthesis of both to MS patients on an approved basis and it is indeed a rare opportunity for MS patients to take advantage of a treatment that is quite possibly unique in the world”. Autologous stem cell transplantation is a procedure by which blood-forming stem cells are removed, and later injected back into the patient. All stem cells are taken from the patient themselves and cultured for later injection. In the case of a bone marrow transplant, the HSC are typically removed from the Pelvis through a large needle that can reach into the bone. The technique is referred to as a bone marrow harvest and is performed under a general anesthesia. The incidence of patients experiencing rejection is rare due to the donor and recipient being the same individual.This remains the only approved method of the SCT therapy. For more information visit http://ccsviclinic.ca/?p=838 |
robert taylor
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... “Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.” Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.” Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary. “That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.” Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on Toll Free: 888-419-6855. |
Leo Voisey
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... Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike "differentiated" cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus. Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it. For example, neural cells in the spinal cord, brain, optic nerves, or other parts of the central nervous system that have been injured can be replaced by injected stem cells. Various stem cell therapies are already practiced, a popular one being bone marrow transplants that are used to treat leukemia. In theory and in fact, lifeless cells anywhere in the body, no matter what the cause of the disease or injury, can be replaced with vigorous new cells because of the remarkable plasticity of stem cells. Biomed companies predict that with all of the research activity in stem cell therapy currently being directed toward the technology, a wider range of disease types including cancer, diabetes, spinal cord injury, and even multiple sclerosis will be effectively treated in the future. Recently announced trials are now underway to study both safety and efficacy of autologous stem cell transplantation in MS patients because of promising early results from previous trials. History Research into stem cells grew out of the findings of two Canadian researchers, Dr’s James Till and Ernest McCulloch at the University of Toronto in 1961. They were the first to publish their experimental results into the existence of stem cells in a scientific journal. Till and McCulloch documented the way in which embryonic stem cells differentiate themselves to become mature cell tissue. Their discovery opened the door for others to develop the first medical use of stem cells in bone marrow transplantation for leukemia. Over the next 50 years their early work has led to our current state of medical practice where modern science believes that new treatments for chronic diseases including MS, diabetes, spinal cord injuries and many more disease conditions are just around the corner. There are a number of sources of stem cells, namely, adult cells generally extracted from bone marrow, cord cells, extracted during pregnancy and cryogenically stored, and embryonic cells, extracted from an embryo before the cells start to differentiate. As to source and method of acquiring stem cells, harvesting autologous adult cells entails the least risk and controversy. Autologous stem cells are obtained from the patient’s own body; and since they are the patient’s own, autologous cells are better than both cord and embryonic sources as they perfectly match the patient’s own DNA, meaning that they will never be rejected by the patient’s immune system. Autologous transplantation is now happening therapeutically at several major sites world-wide and more studies on both safety and efficacy are finally being announced. With so many unrealized expectations of stem cell therapy, results to date have been both significant and hopeful, if taking longer than anticipated. What’s been the Holdup? Up until recently, there have been intense ethical debates about stem cells and even the studies that researchers have been allowed to do. This is because research methodology was primarily concerned with embryonic stem cells, which until recently required an aborted fetus as a source of stem cells. The topic became very much a moral dilemma and research was held up for many years in the US and Canada while political debates turned into restrictive legislation. Other countries were not as inflexible and many important research studies have been taking place elsewhere. Thankfully embryonic stem cells no longer have to be used as much more advanced and preferred methods have superseded the older technologies. While the length of time that promising research has been on hold has led many to wonder if stem cell therapy will ever be a reality for many disease types, the disputes have led to a number of important improvements in the medical technology that in the end, have satisfied both sides of the ethical issue. CCSVI Clinic CCSVI Clinic has been on the leading edge of MS treatment for the past several years. We are the only group facilitating the treatment of MS patients requiring a 10-day patient aftercare protocol following neck venous angioplasty that includes daily ultrasonography and other significant therapeutic features for the period including follow-up surgeries if indicated. There is a strict safety protocol, the results of which are the subject of an approved IRB study. The goal is to derive best practice standards from the data. With the addition of ASC transplantation, our research group has now preparing application for member status in International Cellular Medicine Society (ICMS), the globally-active non-profit organization dedicated to the improvement of cell-based medical therapies through education of physicians and researchers, patient safety, and creating universal standards. For more information please visit http://www.neurosurgeonindia.org/ |
Leo Voisey
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... Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike "differentiated" cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus. Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it.For more information please visit http://www.neurosurgeonindia.org/ |
Leo Voisey
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... Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike "differentiated" cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus. Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it.For more information please visit http://www.neurosurgeonindia.org/ |
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Feedback from clinician is very importantn"Disease dont follow textboooks nowsda...
