How Elastography is Revolutionizing Liver Health and Detoxification

From the 9/26 DETOXSCAN NEWS Presentation of Dr. Robert L. Bard

The liver, often referred to as the body’s master filter, quietly performs hundreds of functions vital to survival. It processes nutrients, regulates hormones, and detoxifies the bloodstream. Yet for decades, when physicians needed to assess liver health—particularly scarring or fibrosis—patients were subjected to one of medicine’s riskiest diagnostic tools: the liver biopsy. While accurate, the procedure carries a risk of uncontrolled bleeding, infection, and hospitalization.

Now, a new wave of non-invasive imaging is transforming this picture. Ultrasound elastography, a technology that measures tissue stiffness to reveal scarring deep within the liver, has become a safer, faster, and more precise alternative. As clinicians embrace this innovation, it is reshaping how doctors track toxic exposures, alcohol-related damage, hepatitis, and even the effectiveness of treatment.

The Hidden Threat of Liver Fibrosis
Liver fibrosis is the gradual build-up of scar tissue caused by injury or inflammation. Left unchecked, it can progress to cirrhosis, liver failure, or even cancer. Historically, detection has been a race against time. Blood tests often fail to pick up early disease, and biopsies only offer a “snapshot” from one tiny piece of tissue, potentially missing the bigger picture.

For decades, many cases of toxin-related liver disease—whether from alcohol, viral hepatitis, or environmental exposures—were underdiagnosed or detected too late. Physicians needed a way to see the full landscape of the liver in real time, without risking patient safety.

From Steelworks to Medicine: The Origins of Elastography
The breakthrough came from an unexpected place: industrial physics. Half a century ago in Chicago, physicists began experimenting with sound waves to test the strength of steel. They discovered that sound traveled quickly through solid, uniform metal but slowed dramatically in areas of rust or weakness.

Translating this principle to medicine, researchers realized the same applied to biological tissue. Healthy liver tissue transmits ultrasound waves smoothly, while scarred or fibrotic areas slow them down. This led to the birth of FibroScan, an early elastography device developed in the late 20th century.

Adoption spread rapidly across Europe. Italian researchers were among the first to apply FibroScan in clinical practice, quickly followed by the French, who refined it for use in patients with alcohol-related disease and viral hepatitis. What began as a niche innovation is now recognized globally as one of the most powerful tools for liver diagnostics.

Quantifying Scarring: A New Diagnostic Era
Unlike biopsies, elastography provides a quantitative measurement of liver stiffness, allowing physicians to monitor changes over time. This means clinicians can answer crucial questions:

• Is the patient’s fibrosis worsening or improving?

• Is a treatment regimen working?

• Should the therapy be stopped or intensified?

In a matter of minutes, elastography offers clarity. A patient can leave the clinic knowing not only whether they have liver scarring, but also whether lifestyle changes or medications are making a difference.

Dr. Robert Bard, a diagnostic imaging specialist, emphasizes the value of this shift: “The test can be done in 15 minutes, without pain or risk, and gives us the ability to validate treatment. Patients no longer have to wait months or face uncertainty—we can track healing in real time.”

Applications Across Disease and Detoxification
The applications for elastography are wide-ranging.

• Alcohol-Related Disease: Chronic alcohol consumption remains one of the most common causes of liver fibrosis. By measuring scarring levels, elastography allows physicians to counsel patients directly on how lifestyle changes are—or are not—protecting their liver.

• Viral Hepatitis: Millions worldwide live with hepatitis B or C, often unaware of their infection until it becomes severe. Elastography enables early intervention and provides a tool for tracking response to antiviral treatments.

• Toxin-Induced Fibrosis: From burn pit exposures in veterans to industrial chemical exposure in workers, toxins are an underappreciated driver of liver disease. Elastography offers a way to monitor these at-risk populations without invasive testing.

• Treatment Validation: In an era where functional and integrative medicine emphasizes detoxification, elastography provides something rare—evidence. Patients using therapies such as chelation, nutritional detox, or lifestyle protocols can now see measurable changes in liver health.

Why This Matters Now
The growing burden of liver disease makes these innovations urgent. The World Health Organization estimates that more than one million people die annually from cirrhosis, and the rates of chronic liver disease continue to climb due to alcohol, obesity, and environmental toxins. Elastography does

not replace traditional medicine but enhances it. By providing early, accurate, and non-invasive insights, it bridges the gap between prevention, clinical monitoring, and functional detox strategies. It allows physicians to pivot care strategies sooner and empowers patients to take active roles in their recovery.

The Future of Liver Health
The story of elastography is a reminder of how technology reshapes medicine when physics, engineering, and clinical care intersect. What began as a tool for testing steel is now saving lives by detecting hidden scars in the body’s most resilient organ. As adoption grows worldwide, elastography stands to become the standard for liver evaluation, replacing biopsies in many cases and expanding into broader applications across kidneys, thyroid, and beyond. For patients, it means fewer risks, fewer unanswered questions, and a better chance to reverse damage before it’s too late.

"In the end, liver health is about more than numbers on a chart—it’s about filtering the toxins of life, both literal and metaphorical. With elastography, medicine now has a window into the body’s resilience, offering hope that healing can be measured, validated, and celebrated." - Dr Robert L. Bard

References  

1. Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(5):1264-1281.e4. doi:10.1053/j.gastro.2018.12.036

2. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705-1713. doi:10.1016/j.ultrasmedbio.2003.07.001

3. European Association for the Study of the Liver (EASL). EASL clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237-264. doi:10.1016/j.jhep.2015.04.006

4. World Health Organization. Cirrhosis. Published 2023. Accessed September 2025. https://www.who.int/news-room/fact-sheets/detail/cirrhosis

5. Boursier J, Zarski JP, de Ledinghen V, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57(3):1182-1191. doi:10.1002/hep.25993

6. Wong VW, Adams LA, de Lédinghen V, Wong GL, Sookoian S. Noninvasive biomarkers in NAFLD and NASH — current progress and future promise. Nat Rev Gastroenterol Hepatol. 2018;15(8):461-478. doi:10.1038/s41575-018-0014-9

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VETERAN DOC'S RESEARCH ON OLD WOUNDS

 

PART 3:

Richard Signarino’s Checkup—and the Bigger Picture for Veterans Who Worked Around Aircraft

When Richard Signarino, a U.S.A.F. veteran who spent part of his service maintaining F-4C fighters, came to Dr. Robert L. Bard for a prostate health checkup, he brought more than routine concerns. Like many veterans who worked on flight lines or in hangars, he wondered whether years around jet fuel, solvents, radar systems, and other occupational exposures could affect long-term health—including prostate cancer risk. Dr. Bard’s exam used high-resolution ultrasound with Doppler and elastography to look beyond a PSA number, mapping gland architecture, vascularity, and any focal stiffness that might warrant follow-up. The scan offered Richard something too many veterans lack: a concrete, real-time picture of the prostate that helps separate worry from actionable findings.

What the research says about aircraft work and cancer

A large Department of Defense analysis of nearly 900,000 aircrew and aviation support personnel (1992–2017) found higher rates of several cancers compared with the general U.S. population. For men, the study reported a 16% higher rate of prostate cancer among aircrew; ground crews also showed elevated incidence for certain cancers. Mortality was lower overall—likely reflecting fitness and access to care—yet the incidence signal has prompted deeper investigation into aviation-related exposures and screening needs.¹

For those on the maintenance side, historical cohorts exposed to trichloroethylene (TCE)—a degreasing solvent widely used in aircraft repair—have been studied repeatedly. Extended follow-up of aircraft maintenance workers shows mixed results on all-cancer mortality, but TCE as a chemical has substantial epidemiologic literature linking it to several cancers; some studies and case evaluations include prostate cancer signals among broader cancer excesses.²⁻³,⁵

Another exposure class is jet fuels (JP-5/JP-8/Jet-A). The ATSDR toxicological profile and VA’s exposure pages summarize neurologic, respiratory, and dermal effects, with cancer associations still being clarified. A 2017 federal review concluded there is limited and inconsistent evidence for cancer risk specifically from jet fuels, underscoring the need for better exposure assessment and long-term follow-up.⁴

Concerns sometimes extend to radar and radiofrequency (RF) radiation. Meta-analyses and pooled evaluations generally do not show a significant increase in overall cancer risk from occupational radar exposure, though case series of young military patients have fueled calls for more granular exposure reconstruction.⁶

In recent years, PFAS (“forever chemicals”) contamination on military bases—often from AFFF firefighting foam—has raised new questions. The National Cancer Institute’s epidemiology group reports that elevated PFAS levels were not associated with increased aggressive prostate cancer in a large prospective analysis, though research continues and exposure scenarios for firefighters and base residents differ.⁷ VA notes potential PFAS exposures for military firefighters and some installations and provides guidance for concerned veterans.⁸

Finally, broader reviews have argued that military veterans should be specifically queried for exposure histories (solvents, fuels, shift work, burn pits, etc.) because several exposures are plausibly associated with prostate cancer risk—even when evidence is not yet definitive.²,³

What’s “publishable” now—without overstating the science

• Aviation cohorts show a signal: DoD’s registry analysis reports elevated prostate cancer incidence among aircrew, with ongoing work to tease out the drivers (chemical, physical, circadian/shift-work, or combined).¹

• Solvent exposure matters: TCE remains a credible mechanistic and epidemiologic concern from aircraft maintenance settings; it is reasonable to document and report solvent histories in occupational prostate health narratives.²⁻³,⁵

• Jet fuel links are not settled: Health effects from JP-5/JP-8 are documented, but cancer associations are limited/inconsistent; any statement should be careful and evidence-proportional.⁴

• Radar/RF evidence is mixed to null overall: You can note no clear overall increase in cancer from radar exposure in pooled analyses, while acknowledging data gaps in individual circumstances.⁶

• PFAS is under study: No clear association with prostate cancer in a large NCI study, but exposure contexts vary, and federal/VA monitoring continues—appropriate to flag in occupational histories.⁷⁻⁸

Translating evidence into action for veterans

For veterans like Richard, the uncertainty can be frustrating. Dr. Bard’s approach is to pair exposure-aware history-taking with precision imaging:

1. Document the exposures. Years/roles on the flight line, tasks (degreasing, fuel handling), PPE use, known base contaminants (PFAS lists), and any radiation-risk activities (which have VA “presumptive” pathways for certain cancers).

2. Screen thoughtfully. PSA and DRE remain standard, but ultrasound adds immediate anatomy: hypoechoic nodules, capsular changes, and power Doppler can highlight suspicious vascular patterns; elastography quantifies focal stiffness. Imaging can triage who needs MRI or biopsy and help target any necessary sampling more precisely—reducing blind procedures and uncertainty.⁹

3. Monitor longitudinally. For veterans with notable exposure histories but equivocal labs, serial ultrasound mapping offers a low-burden way to watch for change—aligning with the DoD study’s implication that some aviation roles may merit closer surveillance, even when absolute risks remain modest.¹

Where aircraft maintainers fit

Aircraft maintainers face a different exposure mix than pilots: more direct contact with solvents (TCE and others), fuels and exhaust, lubricants, and sometimes shift work. The classic maintenance-facility cohorts anchor much of what we know; while not all outcomes rise to statistical significance, they justify exposure documentation and preventive care.²⁻³,⁵

Back to Richard

For Richard, the take-home is clarity and a plan. His checkup with Dr. Bard delivered a baseline prostate map, correlated with his exposure history from F-14 service. If future labs change—or if new symptoms arise—he has a reference point to guide targeted follow-up rather than guesswork. More broadly, his case illustrates how veteran-centric prostate care should work:

• Ask detailed exposure questions from day one.

• Use imaging to reduce uncertainty and personalize next steps.

• Report exposures in clinical notes and, where appropriate, VA claims, leveraging evolving federal guidance.

The science is still maturing, and not every exposure leaves a measurable imprint. But veterans deserve a standard of care that recognizes their unique histories. For aircraft workers, that means acknowledging credible risks (solvents), openly labeling uncertainties (jet fuels, RF, PFAS for prostate cancer), and deploying the best tools we have—like ultrasound—to catch problems early and keep more veterans like Richard on a healthy, informed path.

Educational content only; not a substitute for medical advice. If you’re a veteran with relevant exposures, talk with your clinician about screening and document your service history.

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References

1. Sigurdson AJ, Waters KM, Gaffney SG, et al. Incidence and mortality of cancer among military aircrew and aviation ground crew personnel. JAMA Netw Open. 2022;5(3):e220938. doi:10.1001/jamanetworkopen.2022.0938

2. National Research Council (US) Committee on Human Health Risks of Trichloroethylene. Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues. Washington, DC: National Academies Press; 2006.

3. Scott CS, Jinot J. Trichloroethylene and cancer: systematic and quantitative review of epidemiologic evidence for identifying hazards. Int J Environ Res Public Health. 2011;8(11):4238-4271. doi:10.3390/ijerph8114238

4. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Jet Fuels (JP-5, JP-8, Jet A). Atlanta, GA: US Department of Health and Human Services; 2017.

5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Trichloroethylene, Tetrachloroethylene, and Some Other Chlorinated Agents. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 106. Lyon, France: International Agency for Research on Cancer; 2014.

6. Blettner M, Schlehofer B, Samkange-Zeeb F, Berg G. Medical exposure to radiofrequency and extremely low-frequency electromagnetic fields and risk of cancer: review of epidemiological studies. Radiat Environ Biophys. 2009;48(1):1-11. doi:10.1007/s00411-008-0206-8

7. Purdue MP, Lan Q, Baris D, et al. A prospective study of serum per- and polyfluoroalkyl substances and prostate cancer risk. Environ Health Perspect. 2023;131(2):27003. doi:10.1289/EHP11153

8. Veterans Affairs Office of Public Health. Military exposures: PFAS. US Department of Veterans Affairs website. Updated 2023. Accessed September 14, 2025. https://www.publichealth.va.gov/exposures/pfas/index.asp

9. Donovan JL, Hamdy FC, Lane JA, et al. Screening, detection, and treatment of prostate cancer: evidence from randomized trials. Lancet. 2016;387(10013):1227-1237. doi:10.1016/S0140-6736(15)01038-0