A s u p p l e M e N t t o W e s t c h e s t e r h e a lt h & l i f e M A g A Z i N e F r o M Westchester medica l c e n t e r
advances in medical
technology
‘A roBot sAVED MY KIDnEY’
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contents
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welcome letter
14 T h i s s p e c i a l s u p p l e m e n t to W e stc h e st e r H e a lt h & L i f e m a g a z i n e is an introduction to the up-tothe-minute medical technology available at Westchester Medical Center. We have invested in some of the most exciting equipment available
advances in MEDICAL
technology
today. In this supplement, you will read about advanced tools that enable our physicians to solve perplexing puzzles and treat complex illnesses. You will learn how our 256-slice CT scanner and 3-D echocardiography system help physicians diagnose heart disease, and how interventional cardiology procedures and mechanical heart devices save lives. In
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women’s imaging, our digital mammography technology and special
3 m e d i c a l t e r m i n o lo gy
Children’s Hospital, innovative devices save newborns’ lives and bring
breast MRI coils are used to detect early breast cancer. At our Maria Fareri
today—and tomorrow
4 p i c t u r e s
older children back from disaster. Our robot-assisted surgical services reduce pain, lessen the risk of complications and shorten recovery times for patients undergoing minimally invasive procedures. I invite you to learn about these impressive machines and the skilled
that save lives
physicians, nurses and technologists who use them to save lives every
6 c l e a r e r s c a n s ,
day. For more information, please visit www.WorldClassMedicine.com.
less radiation
8 d a m ag e d h e a r ts , restored
Michael D. Israel President and CEO Westchester Medical Center
12 a dva n c e s t h at help sick kids
14 T h e
r o b ot i c s
revolution Advances in Medical Technology is published by Wainscot Media, Montvale, NJ. © 2010. All rights reserved.
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Medical technology
today—and tomorrow State-of-the-art tools play a vital part IN diagnosing and treating illness
Machines can do wondrous
permits the cost-effective acquisition
involving state-of-the-art technology
things. In medicine, technology helps
and maintenance of proven cutting-
will begin or reach completion at
dramatically to save, extend and
edge equipment to enable the Medical
Westchester Medical Center. These
improve lives—and nowhere is this truer
Center to render superb care for
include complete upgrades to the
than at Westchester Medical Center.
patients. Because Westchester Medical
electrophysiology and cardiac
Whether you need a routine screening
Center is also a leading academic and
catheterization labs, the addition of
for possible disease or a potentially
research institution, the technology
a new “hybrid” operating room for
lifesaving treatment, you turn to a top-
helps to educate tomorrow’s healthcare
neurovascular procedures (those
level medical facility like Westchester
professionals and aid investigators
involving the blood supply to the
with a well-placed confidence that it
seeking to expand the boundaries of
brain) and cardiac procedures, and the
will employ the latest and finest tools.
medical knowledge.
purchase of a new linear accelerator and
But make no mistake—machines are not
In recent years, Westchester Medical Center has added some
what matters most. “We’ve assembled a world-class
of the most exciting diagnostic
CyberKnife radiosurgery system to treat patients with cancer and other diseases. The advanced technology and
team of clinicians, researchers and
and therapeutic technology on the
specially trained physicians, nurses and
educators whose expertise impresses
market today—notably a 256-slice CT
staff at Westchester Medical Center are
us every day and whose commitment to
[computed tomography] scanner that
valuable resources to the more than
their patients remains their top priority
can capture a clear image of a heart
3.5 million people in the Hudson Valley
at all times,” says Michael D. Israel,
in two heartbeats, and Cool-Caps that
Region. No matter the complexity of
Westchester Medical Center’s President
prevent brain damage in severely ill
the disease, injury or condition, from
and Chief Executive Officer. “Their
newborns. The Medical Center’s tools
the tiniest patient to the most mature,
human contribution is paramount.
for battling heart disease include
Westchester Medical Center utilizes the
But the technological breakthroughs
drug-coated stents and implantable
most advanced care possible to save lives.
we utilize become the conduits
mechanical heart-assist
through which their knowledge and
devices that keep heart-
dedication shine.”
failure patients alive—with
Every day at Westchester Medical
a good quality of life—even
Center, state-of-the-art technology is
if they’re not candidates
used to highlight the inner workings
for a transplant. Using the
of the body with astounding clarity and
robotic da Vinci Surgical
to treat illnesses with an effectiveness
System, physicians are
that was unmatched a generation or
pushing the dexterity and
even a decade ago. And much of this
precision of the robot’s
technology is available nowhere else in
“arms” into new frontiers
the Hudson Valley region.
in minimally invasive gynecologic and urologic
On the next few pages, you’ll read about some of the advanced devices used at Westchester Medical
procedures. Over the next
Center. This equipment requires the
few years, several
investment of significant resources—a
large renovation and
carefully considered process that
modernization projects
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pictures that
save lives The Women’s I maging Center combines state-of-the-art equipment with the finest clinical expertise
When cancer or other
Medical College. “He is widely respected
imaging to aid in the diagnosis and
serious illness is a possibility—even if
in the Westchester area, not only for
treatment of breast cancer and other
it’s only a routine screening—a woman
his expertise in breast imaging and
breast diseases.
wants to be confident she’s benefiting
procedures but also for his advocacy of
from the best: the latest technology,
women’s access to high-quality breast
accommodate a variety of breast sizes,
the finest clinicians. That confidence is
care services.” Dr. Sanchez is joined by
which makes the test more comfortable
assured at Westchester Medical Center’s
radiologist Alex Maderazo, M.D., Chief of
for our patients,” says Dr. Sanchez, who is
new, 5,000-square-foot Women’s
Musculoskeletal Imaging at Westchester
an assistant professor of radiology at New
Imaging Center.
Medical Center, and a staff of technologists
York Medical College. “The images help us
The only facility of its kind in the lower Hudson Valley, the center offers screening and diagnostic breast imaging tests and bone density screenings. “We’re fortunate to have recruited
“We can adjust the coil to
certified in mammography, ultrasound and magnetic resonance imaging (MRI). Amenities at the Women’s Imaging Center are superb: a private entrance, valet
the women’s
imaging center
parking, plush robes and appealing décor.
Dr. Julian Sanchez as Medical Director,”
One floor down from the center
says Zvi Lefkovitz, M.D., Director of the
proper, a new MRI machine has been
Radiology Department at Westchester
outfitted with a special coil to hold breasts
Medical Center and chairman of the
in place. Under the center’s auspices, it
Radiology Department at New York
is used to provide high-resolution breast Services at the center include: • low-dose digital screening and diagnostic mammograms (including—alone in the region—galactogram, a type of digital mammogram that evaluates the breast’s milk ducts for masses) • high-resolution breast sonograms (ultrasounds) • minimally invasive breast biopsies with stereotactic guidance (that is, guided by a technology that provides precise positioning in threedimensional space) and ultrasound guidance • breast MRIs • bone density screenings • vertebral fracture assessments
Julian Sanchez, M.D., Medical Director of the Women’s Imaging Center, reviews digital mammography images.
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of all women “called back” after an initial mammogram, only 8 to 10 percent will require a biopsy— and 80 percent of those biopsies will not be cancer.
Julian sanchez, m.d.
zvi lefkovitz, m.d.
alex maderazo, m.d.
to examine dense breast tissue, confirm a
this procedure the doctor employs a
services to keep them at the forefront of
diagnosis, evaluate the extent of disease
special needle-like device with a quick,
medicine’s capabilities. In the few months
and plan surgery if necessary.”
vacuum-like motion.
since it opened, it has already added
“The patient may feel a little pinch,
three key enhancements:
taking breast biopsies
but that’s it,” he explains. “no incision is
When a lesion is found on the breast,
made in the breast.”
breast biopsies
clinicians to study the tissue to see if
detecting bone loss
MRI software to enable detection of
it is cancerous. Dr. sanchez is skilled
Osteopenia, considered a precursor to
breast abnormalities in greater detail
in performing nonsurgical breast
osteoporosis, is lower-than-normal bone
than ever before
biopsies with needle aspiration to draw
mineral density. People with osteopenia
out the cells needed for pathological
or osteoporosis have thin, brittle bones
picture archiving and communication
examination. stereotactic guidance
that put them at risk for fractures of
system (PACs) with those of other
assists him in locating a suspicious
the arms, legs, hips and spine. These
imaging centers so that digital images
lesion found on a mammogram, while
fractures can lead in a downward spiral
can be transmitted to the center and
ultrasound guidance helps to identify one
to the loss of mobility and independence.
stored for easy retrieval.
a biopsy is performed to enable
that has been felt by either a patient or her physician.
• super-sensitive, diffusion-weighted
(DEXA) bone density scans screen
inconclusive, it’s sometimes necessary
patients for osteopenia and osteoporosis.
to extract tissue in an operating room.
Painless and requiring less radiation than
But prior to these surgical biopsies,
a standard X-ray, a DEXA scan helps Dr.
Dr. sanchez (in the Women’s Imaging
Maderazo detect bone loss, determine
Center) may perform a procedure called
the rate of bone loss, confirm a diagnosis,
needle localization. Using ultrasound to
predict a patient’s chances for a fracture
identify the exact area of the breast that
and monitor the effects of medical or
needs to be biopsied, Dr. sanchez then
surgical treatment.
places a needle or thin wire at the site to
• the integration of the center’s
At the Women’s Imaging Center, dual-energy X-ray absorptometry
If a nonsurgical biopsy is
• MRI-guided, vacuum-assisted
“A DEXA scan is the ‘gold standard’
alert the surgeon to where tissue needs
of bone density screening,” says Dr.
to be removed.
Maderazo. “At our center, we also offer patients a second test, a vertebral
When tumors are benign
fracture assessment, to check for
Fibroadenomas—benign breast
fractures of the thoracic and lumbar
tumors—account for about 50 percent
spine.” The Women’s Imaging Center
of all suspicious breast lesions, says Dr.
is one of only a few sites in the lower
sanchez. The Women’s Imaging Center
Hudson Valley where this test is available.
is the only facility in the region that performs ultrasound-guided, vacuum-
on the cutting edge
assisted percutaneous (through-the-
The new Women’s Imaging Center is
skin) removal of fibroadenomas. For
committed to constantly improving its
ARE YOU AT RIsK FOR
osteoporosis? you could be among the 12 million americans with osteoporosis, which costs the u.s. $17 billion each year in medical fees, lost wages and other losses. to assess your risk, your doctor may recommend a dexa bone density scan if you’re: • a woman age 65 or older or a man age 70 or older • a menopausal woman with another risk factor such as low body weight • over 50 and have had a bone fracture • taking a medication such as prednisone that is associated with bone loss
WOMEn’s IMAgIng CEnTER 914-493-2500 | WWW.Worldclassmedicine.com/imaging
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cleArer scANs,
less radiation
thanks to its split-second timing, the 256-slice ct scanner is a cutting-edge diagnostic tool
in about five seconds—
around the body as it scans, we can
heart’s blood vessels, determine if there
less than two heartbeats—Westchester
obtain an image of the entire body
is narrowing in the arteries or veins of
Medical Center’s most advanced
within one minute, exposing the patient
a patient’s legs or arms, or detect a
diagnostic imaging tool can produce
to 80 percent less radiation than a
potentially fatal thoracic or abdominal
a detailed, sparkling-clear image of a
traditional CT scanner, which can
aortic aneurysm (a weakened or
living heart. For patients, that’s more
only scan about one-quarter of the
bulging spot in a blood vessel). Cardiac
than a believe-it-or-not statistic. It
body at a time,” says Amar shah, M.D.,
surgeons often order a 256-slice scan to
means the ability to guard your health
Director of Cardiac and Vascular MRI
map and assess a patient’s old bypass
more effectively and more safely.
and CT at Westchester Medical Center.
grafts prior to a second coronary artery
“Our 256-slice scanner’s speed often
bypass surgery. Because the scanner
tool, the medical center’s 256-slice
eliminates the need for contrast dye to
is so fast, it can be used to evaluate
computed tomography (CT) scanner—
aid in visualization. That’s a blessing for
congenital heart defects in children
the only one in the lower Hudson
patients who are allergic to contrast
without sedation.
Valley—is used to find blockages in
material or cannot tolerate it due to
blood vessels and other irregularities
poor kidney function.”
A superior diagnostic imaging
that can spell trouble. Its name reflects
evaluating patients at low risk for heart disease, such
The scanner helps to
the fact that it sends out 256 pulses
diagnose heart disease
every one-third of a second to capture
by spotting abnormal
visual “slices” of organs, blood vessels
blood flow through
and other structures in the body. The
arteries and veins that
scanner features ultra-high–resolution
are no wider than a
3-D imaging that significantly reduces
toothpick. Using the
the amount of radiation necessary to
images it produces, Dr.
complete a test.
shah can observe tiny
“Because it’s so fast and rotates
“This scanner is also ideal for
blockages forming in the
an estimated 70 million computed tomography (ct) scans were performed in the united states in 2007. that’s a threefold increase from 1993.
as those who have a borderline positive result on a stress test, have moderate chest pains, or are under age 55 with no history of heart disease,” says Dr. shah. “It can help them avoid a more
these images from Westchester medical center’s 256-slice ct scanner hint colorfully at this advanced technology’s ability to find and identify problems so they can be treated promptly.
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Amar Shah, M.D.
extensive cardiac catheterization test,
MRI: where power
which we would order for a person at
aids precision
high risk.” A tool to fight stroke The 256-slice scanner can also create a detailed image of the human brain—in one second. For a patient who arrives at the Emergency Department with stroke symptoms, neuroradiologist Hasit Mehta, M.D., uses the scanner to perform a test called a CT brain perfusion scan, in which a series of images produced within 45 seconds delineates how the brain is fed its blood and if there is a blood clot lurking in an artery to the brain. “The scanner’s speed allows me to look at more of the brain at once and at the tiny structures that can be affected by a tumor, blockage or aneurysm,” says Dr. Mehta. Information from the brain images also assists surgeons in planning treatment for blockages of the carotid arteries in the neck or for a congenital condition called arteriovenous malformation, in which blood vessels are tangled in the brain. Scanning stationary tissue But sometimes top speed isn’t required, and Westchester Medical Center’s latestgeneration 64-slice CT machine suffices nicely. Says Zvi Lefkovitz, M.D., Director of Radiology at Westchester Medical Center and chairman of the Radiology Department at New York Medical College: “It excels at producing highquality images of bones or organs that do not pose motion issues—for example,
For some situations, magnetic resonance imaging (MRI) is a more appropriate imaging technology than CT. MRI does not require exposure to radiation; instead, it works by placing the body in a magnetic field, introducing radio frequencies and seeing how the body’s tissue reacts. In MRI, the strength of the magnet is critical. Westchester Medical Center is the only facility in Westchester County with a 3 Tesla MR imaging system that is twice as strong as conventional MRI machines. Its superior speed aids neuroradiologist Hasit Mehta, M.D., in pinpointing the exact area of the brain that may be affected by a tumor or a blockage that disrupts normal blood flow. “Every brain is different, and tumors often alter normal anatomy,” says Dr. Mehta. “By having the patient move his or her hand, speak or read during the MRI exam, I can map out where critical brain structures are so that a neurosurgeon can avoid them during surgery.” Cardiac MRI tests provide accurate measurements of heart function, heart rate and how well the heart muscle is pumping. Cardiologists often use a cardiac MRI in tandem with an echocardiogram to assess heart valves and whether they need to be repaired or replaced. Both CT and MRI technology guides Dr. Mehta and other neuroradiologists at the Medical Center in performing minimally invasive interventional procedures to treat pain caused by spinal compression fractures and to support remaining bone. These procedures include vertebroplasty (in which cement is injected into a fractured vertebra) and kyphoplasty (in which cement is used to restore a collapsed vertebra). “Having several neuroradiologists on staff at Westchester Medical Center means we’re able to provide the highest-quality imaging services and interventional procedures,” says Director of Radiology Zvi Lefkovitz, M.D. “This is especially important to us as a Level I trauma center, because we treat many patients with head injuries or other neurological emergencies.”
the gastric or urinary systems.”
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Damaged hearts,
restored
From clearing blocked arteries to regulating cardiac rhythms, today’ s technology is saving—and dramatically improving— the lives of patients with coronary disease
B e n j a m i n A n g e l , 74 , o f Malverne remembers the day not long ago when he barely had the strength to button his shirt. His enlarged heart was pumping at only 15 percent of capacity, and his diminished appetite had caused him to lose 30 pounds. But today, thanks to a small mechanical pump called a left ventricular assist device (LVAD), the retired corporate comptroller is driving, shopping, walking up and down stairs and enjoying time with his four grandchildren. “I feel reborn,” says Angel. “And my doctor says I’m almost ready to get back on the golf course.” Angel is a walking testament to a technological revolution. In the last half-century, cardiology has evolved from a mostly diagnostic subspecialty of internal medicine to a robust discipline that dramatically extends thousands of lives—and improves their quality too. Technology is at the heart of this transformation, and the doctors at Westchester Medical Center are national leaders in applying technology to the battle against cardiovascular disease, still the nation’s number-one killer. Melvin Weiss, M.D., Chief of Cardiology, who began practicing in 1972, has seen much of the change himself. “When I started out, 50 percent of patients suffering heart attacks died before they reached the emergency room,” he recalls. “For those who made it to the hospital and survived, there was little we could do except to make them comfortable, prescribe morphine for the pain and ask the nurses to hold Life has been fuller for Benjamin and Rachel Angel of Malverne since he received a mechanical pump that gives a big assist to his heart.
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melvin Weiss, m.d.
anthony pucillo, m.d.
alan gass, m.d.
John mcclung, m.d.
carmine sorbera, m.d.
their hands. But it’s a very different
healthier lifestyles and new medications,
stents, which have reduced restenosis
world today.”
the fact that this time period coincides
rates to 5 percent,” says Dr. Pucillo.
with the development of drug-eluting
“If bioabsorbable stents can reduce
[-coated] stents is not coincidental.”
restenosis rates even lower, we might
unblocking arteries The change began with the advent
At Westchester Medical Center,
consider using them.” To reduce the risk of stroke by
of coronary artery angioplasty in the
Anthony Pucillo, M.D., Director of the
early to mid-1980s and the rise of
Cardiac Catheterization laboratory,
preventing blood clots from forming
the subspecialty called interventional
and other interventional cardiologists
around stents—which over time are
cardiology. For the first time, a
use five different first- and second-
covered by cells and become part of the
nonsurgical treatment could be used to
generation drug-coated stents to treat
wall of the artery—patients with stents
open up blocked coronary arteries that
and prevent heart attacks.
must take anti-platelet medications.
“In the event of an acute heart
Dr. Pucillo and his research team are
threatening one. Deflated balloons sitting
attack, the ‘golden’ treatment time
participating in several clinical
atop thin tubes were threaded into
from door to completion is 90
arteries through a catheter via a patient’s
minutes, a goal we achieve
groin and then guided up to a blockage.
every day at Westchester
The physicians then inflated the balloons
Medical Center,” he
to open the arteries without having to
says. “Today’s drug-
cut open a patient’s chest.
eluting stents are so
either had led to a heart attack or were
In the 1990s, tiny metal scaffolds
effective that when
called stents began to be used to keep
we place them, we are
arteries open once they had been
confident we will get a
cleared of plaque by the balloons
positive long-term result
or tiny “roto-rooters.” By the dawn
for the patient.”
of the 21st century, interventional
trials to assess the effects of combining anti-
each year, about 1 million americans undergo angioplasty procedures to clear blocked arteries.
platelets for blood clot prevention and to test how long patients should use these medications following angioplasty. Within the next two years, Westchester Medical Center’s six cardiac catheterization
Dr. Pucillo, an associate
cardiologists were using stents coated
professor of medicine at
with medications that interfered with a
new York Medical College, is less
rooms—where diagnostic angiograms and interventional cardiac
process called restenosis (re-blockage).
enthusiastic about bioabsorbable
procedures are performed—will
scientists learned that restenosis is not
stents, now in clinical trials in Europe,
undergo a complete renovation and
due to a recurrence of coronary artery
which some refer to as the “fourth
upgrade in technology. The addition
disease, but instead to the growth
revolution” in interventional cardiology
of a “hybrid” operation room, to be
of smooth muscle cells over the area
(after angioplasty, stents and drug-
used by interventional cardiologists
treated, much as a scar forms over
eluting stents). After doing their job in
and cardiac surgeons alike, will enable
an injury.
preventing restenosis, bioabsorbable
these two specialties to work together
stents break down and are reabsorbed
to treat adults and children with
into the body.
many types of heart, vascular and
“From 2002 to 2007, there was a 23 percent drop in the number of heart attacks in the senior population,” says
“The data from European trials
neurological conditions, including aortic
Dr. Weiss, a professor of medicine at
so far are encouraging but not
aneurysms—weakened or bulging spots
new York Medical College. “Although
overwhelming, so at this time I see
in the aorta, the main artery leaving
some of this can be attributed to
no clear advantage over drug-eluting
the heart. COnTInUED On PAgE 10
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Damaged hearts, restored Continued from page 9
Help for failing hearts Mechanical devices that assist the heart
donor could be found. The latest generation short-
pump pulls oxygenated blood from the heart’s left atrium and returns it
in performing its pumping and blood
term “bridge to recovery” or “bridge
into circulation in the body. A battery-
circulation duties have been around
to transplantation” device in use at
operated controller provides power to
since the late 1960s, when intra-aortic
Westchester is the percutaneous
the pump and sends off an alarm if the
balloon pumps first began pushing
(through-the-skin) TandemHeart
heart experiences any disturbances.
blood through the bodies of patients
system. This device can be put
whose hearts were failing. Over the
into place quickly within a cardiac
of the leading sites using TandemHeart,”
years, Westchester Medical Center has
catheterization lab and does not
says Alan Gass, M.D., Medical Director of
introduced a number of short-term
require surgery or a large chest incision.
Heart Failure, Heart Transplantation and
mechanical heart devices that have
Instead, plastic tubes called cannulas
Mechanical Circulatory Support. “With
helped patients recover after a cardiac
are threaded up to the heart’s left
the TandemHeart, we have been able to
event or cardiac surgery or—in the case
atrium from within a skin puncture at
save 70 percent of all patients suffering
of patients with end-stage heart failure—until a
the patient’s groin. The cannulas attach to a pump worn outside
heart-transplant
the body on the waist. The
“Westchester Medical Center is one
a massive heart attack who receive the device. TandemHeart gives us up to 10 days to initiate the next course of treatment for the patient.” Pioneering alternative In January 2010, the medical center became one of only 20 institutions in the United States to begin using the HeartMate II LVAD like the one that helped Benjamin Angel as a longterm “destination therapy.” Initial data collected by Dr. Gass and other researchers at Westchester Medical Center, who participated in clinical trials for the device, show that LVADs can provide long-term circulatory support for patients who aren’t transplant candidates because they are too old, decline one for religious reasons or have other conditions that make a transplant inadvisable. “Being able to use the LVAD as destination therapy is a major step forward in the long-term management of patients with end-stage heart failure,” says Dr. Gass, an associate professor of medicine at New York Medical College. “New data show that 80 percent of patients with LVAD are alive after three years and 70 percent after five years.” The LVAD is a small pump that has two hoses, one that pulls blood out of the left ventricle and another that pushes
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resarch data suggest that the left ventricular assist device (lvad) improves survival rates by about 40 percent.
it into the aorta. Cables run out of a port in the abdomen and attach to a battery pack the patient wears around the waist or to a battery in the home.
with state-of-the-art
pacemakers or implantable cardioverter
technology to locate,
defibrillators (ICDss) that regulate
diagnose and treat
heart rhythms.
Three-dimensional mapping technology,
which involves threading
The battery can be charged overnight while the patient sleeps.
Drs. sorbera and Cohen have
heart arrhythmias.
intravenous catheters into blood vessels and heart tissue, will
also performed more than 5,000 catheter ablations, a treatment that utilizes electrocautery or heat energy (radiofrequency) to destroy the tissue causing the arrhythmia. “Ablation is
help Dr. sorbera and his colleague,
an effective nonsurgical treatment for
“phenomenal,” says Dr. gass—and
electrophysiologist Martin Cohen,
atrial fibrillation, which is difficult to
Angel heartily agrees. He has felt
M.D., home in on the exact site of the
cure,” explains Dr. sorbera. Other kinds
remarkably better and stronger since
arrhythmia. Treatments aided by this
of arrhythmia, he adds, are “up to 95
he underwent surgery on May 19, 2010,
advance may include implantable
percent curable.”
The benefits of an lVAD can be
to implant the device. “Ben was in and out of many hospitals before his operation,” says
ECHOCARDIOgRAMs:
his wife, Rachel. “no one treated him
3-d VieWs of the heart
as well as the doctors and nurses at Westchester Medical Center.” regulating heartbeats For 20 years, patients with heart arrhythmias—potentially life-threatening disturbances of the heart’s intricate electrical system—have benefited from Westchester Medical Center’s electrophysiology services. Arrhythmias occur when an abnormality of the heart tissue disrupts the electrical system and causes the organ to beat too slowly or too fast, or to skip a beat. “The population in the lower Hudson Valley is aging, and arrhythmias tend to be more common in elderly people,” says Carmine sorbera, M.D., Director of Westchester’s Electrophysiology laboratory and an associate professor of medicine at new York Medical College. “There are at least 2.4 million people in the United states who are living with one particularly dangerous heart rhythm called atrial fibrillation, in which the heart quivers and cannot beat properly.” In the fall of 2010, Westchester will open a new and expanded
When cardiologists need to assess the structure and function of a heart—an adult’s or a child’s—one of the best and least uncomfortable tests is the echocardiogram. this diagnostic test uses sound waves bounced against the walls of the heart and other internal structures to create a moving image of the heart. the doctor can watch the heart beat, look at its valves, see whether the septum that separates the two chambers of the heart is intact, and watch blood flow through the heart. the patient is not exposed to any radiation during an echocardiogram. during the test, a physician specializing in echocardiography or a technologist places a small probe called a transducer on the patient’s chest to pick up the sound waves. an echocardiography machine then converts these impulses into two-dimensional pictures of the heart. Westchester medical center’s echocardiography system takes the technology one step ahead with three-dimensional capability that provides cardiologists with even greater clarity in examining the heart and planning treatment. “this is a big advantage over 2-d systems, because we can see in colors and shadows what the heart’s anatomy looks like, if there are lesions of the valves, and what congenital abnormalities are present in both children and adults,” says John mcclung, m.d., director of Westchester medical center’s noninvasive cardiology laboratory and a professor of clinical medicine and clinical public health at new york medical college. “these nuances can assist us in deciding how to proceed with emergency treatment, and they can help our cardiac surgeons plan corrective surgery.” the 3-d technology can also be used during a transesophageal echocardiogram, which involves placing a transducer on the end of a scope that is inserted down the patient’s throat. transesophageal echocardiograms are commonly used to diagnose endocarditis—an infection of the heart chambers and valves—and small clots in the heart that result from a stroke.
Electrophysiology laboratory, outfitted
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AdVANces thAt
help sick kids When a child’s life is in danger, these 4 technologies can make a big difference
Jack ruffles Was a full-term
using the most compassionate approach,”
communicating with other cells—even
baby when he was born in March 2009,
says Michael gewitz, M.D., Physician-in-
without oxygen, so they burn out and
but his heart was barely functioning.
Chief of Maria Fareri Children’s Hospital
die. Cooling these cells for 72 hours
At Westchester Medical Center, a
and a professor and vice-chairman of
slows their firing.”
device called a Cool-Cap lowered the
pediatrics at new York Medical College.
temperature of his head to 50 degrees
“We’re fortunate to have these folks too.”
A Cool-Cap fits over a newborn’s head. Very cold water circulates through the device, cooling the scalp and slowing
F., preventing damage to his brain for a critical 72 hours while his heart-rhythm
preventing damage to tiny brains
down brain activity. A warming bed
and breathing problems were addressed.
little Jack Ruffles suffered from hypoxic
keeps the rest of the baby’s body warm.
now Jack is a healthy 19-month-old.
ischemic insult, a drop in oxygen delivery to the brain, which occurred when for
pinch-hit for hearts and lungs
youngsters who have benefited from the
unknown reasons his placenta had
Extracorporeal membrane oxygenation,
advanced equipment this hospital offers.
separated from his mother’s uterus.
or ECMO, does the work of a child’s
Its facilities, including the level IV, the
“Because Jack’s heart had stopped,
heart and lungs for a time, allowing
highest level, neonatal intensive care unit
his brain wasn’t getting oxygen, and
these organs time to recover their
(nICU) and the pediatric intensive care
that can cause the death of brain
function. Maria Fareri Children’s Hospital
unit (PICU), offer a level of care available
cells,” explains lance A. Parton, M.D.,
is the only children’s facility in the lower
nowhere else in the lower Hudson Valley,
Associate Director of the
and technology is one of the reasons.
nICU. “The brain can
“Of course, to be successful, technology
become damaged
must be applied by physicians, nurses and
because those cells
other professionals with the finest training
keep ‘firing’—
He’s one example of the many
Hudson Valley where ECMO is available. ECMO technology works like a heart-lung bypass machine, and is usually reserved for critically ill children who continue to get sicker despite standard life-support therapies—including children born with complex congenital problems and those with severe infections or respiratory distress. It may also be used before or after complicated emergency heart surgery. ECMO pumps the blood through equipment that removes carbon dioxide and adds oxygen from the lungs. The oxygenated blood is then returned to the patient, while he or she breathes with the help of a ventilator. “ECMO is a lastresort therapy, but it has saved the lives of
matthew ruffles and marissa bonney were grateful that the “cool-cap” spared their son, Jack, possible brain damage.
12
advances in medical
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Michael Gewitz, M.D.
Lance A. Parton, M.D.
Aalok Singh, M.D.
Henry Issenberg, M.D.
Michael Tobias, M.D.
Avinash Mohan, M.D.
some of the sickest children we’ve cared
Brain surgery, simplified
for,” says Aalok Singh, M.D., a pediatric
Michael Tobias, M.D., and Avinash
intensivist (specialist in the care of critically
Mohan, M.D., Co-Chiefs of Pediatric
patients to avoid a large incision and
ill children) at Maria Fareri Children’s
Neurosurgery, have been performing
results in a quicker surgery, less trauma
Hospital and an assistant professor of
minimally invasive endoscopic
to the brain, minimal blood loss and
pediatrics at New York Medical College,
neurosurgical procedures within adults’
reduced risk of complications, infections,
who supervises the program.
and children’s brains for some time. But
or damage to other brain tissue.”
crush the tumor and then remove it. Says Dr. Mohan: “The Myriad allows
today’s Myriad tissue-dissection device Evaluating hearts in 3-D If doctors suspect a structural
dramatically improves these procedures. “This device changes everything—
abnormality of the heart, such as a hole
it’s what was missing in endoscopic
or damaged valve, one of the hospital’s
pediatric neurosurgery,” says Dr. Tobias,
13 pediatric cardiologists may order
an assistant professor of neurosurgery
an echocardiogram. This painless,
and pediatric neurosurgery at New York
noninvasive test uses sound waves to
Medical College. “Instead of pecking
create images of the heart’s valves and
away at a mass for an hour, you can draw
chambers and has become a standard
it up in minutes, as if through a straw.”
test in pediatric cardiovascular care. But the 3-D echocardiography
pedal operated by the neurosurgeon.
is a big advance over standard 2-D
Employing a Stealth navigation system
echocardiograms. Pediatric cardiologist
that works like the global positioning
Henry Issenberg, M.D., uses this technology
system (GPS) in a car to avoid crucial
to examine babies’ hearts to determine the
“eloquent” sections of the brain, the
extent of severe congenital defects.
neurosurgeon first locates the best area to approach the mass. A sheath,
about the size of a walnut, which may
like that which covers a knife, is placed
have many malformations,” says Dr.
inside a dime-sized hole in the skull to
Issenberg, Director of the Pediatric
create a tunnel through the brain’s fluid-
Echocardiography Laboratory and an
filled ventricles. An endoscope holding
associate professor of pediatrics at
a cannula (thin tube) goes through the
New York Medical College. “We look at
sheath and pops out into the ventricle
moving real-time images of the heart
where the tumor is. The doctor views the
with various shades of color giving
area on a high-resolution monitor.
us a 3D perspective. This volumetric
real child
The Myriad uses automated pumping action controlled by a foot
available at Maria Fareri Children’s Hospital
“We’re talking about a heart that’s
Almost like a
The cannula has a thin, blunt pencil-
image can be manipulated in multiple
tip shape that pierces the lesion like a
planes so doctors can better assess
thin needle. Using the foot pedal, the
how the structure and function of heart
neurosurgeon can rotate the cannula
components interrelate and develop
360 degrees and control the amount of
better plans for medical or surgical care.”
traction, tension and suction needed to
As the major teaching affiliate of New York Medical College, Maria Fareri Children’s Hospital at Westchester Medical Center has a mission that includes educating medical students and residents. A new tool used in this process is a “child simulator” that can be programmed to choke, to stop breathing, to suffer a seizure or to go into full cardiac arrest. As a medical student or pediatric resident treats the “child,” success or failure becomes immediately apparent, explains Michael Gewitz, M.D., the hospital’s Physician-in-Chief. The simulator’s videotaping function enables students and their teachers to review their performance for immediate feedback and to be ready when the real-life test arrives.
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the roBotics
revolution the da vinci robot improves a surgeon’s dexterity—and for one Woman the difference meant saving a kidney
for almost 10 years,
unusual, doctors discovered she had a
Cortlandt Manor resident susan
cantaloupe-sized cyst growing ominously
Cunningham lived with what was
from her right kidney, jostling her other
could remove the tumor using a
diagnosed as a hernia by more than one
abdominal organs out of place. Her
surgical robot and save my kidney, I
doctor. In truth, there was a large cyst on
doctors recommended it be removed,
cancelled the Manhattan appointment,”
one of her kidneys that endangered that
but didn’t think her kidney could be
says Cunningham. “I had complete
organ. Fortunately, surgery at Westchester
saved because of the cyst’s large size.
confidence in him.”
Medical Center was able to save her
“When Dr. Phillips told me he
“By April I’d seen several internists,
kidney—thanks to an expert physician and
urologists and gastroenterologists,
a dramatic surgical advance
the da Vinci surgical system, an important
and I was not satisfied with the
For several years now, the use of a
technological advance that has brought
different treatment options they were
laparoscope (a type of endoscope, a
new precision to the operating room.
suggesting,” recalls Cunningham, 53.
lighted tube with a tiny video camera)
Cunningham wasn’t in pain, and at first she sought no treatment— although a slight belly bulge made her self-conscious
she made two final appointments.
has enabled surgeons to perform many
One was with Westchester Medical
procedures by making half-inch incisions in
Center’s Chief of Robotic
the skin instead of cutting through muscle.
Urologic surgery, John l.
This “minimally invasive” approach has
Phillips, M.D., who had
dramatically reduced pain and blood loss
fitting clothing. But
been recommended
and made it possible for patients to leave
after an ultrasound
by her husband’s
the hospital sooner and recover more
examination
physician.
speedily. Today, robot-assisted surgery
in March 2010
The second
with the da Vinci surgical system takes
showed something
appointment was at
minimally invasive laparoscopic surgery
about wearing close-
14
a renowned Manhattan hospital.
advances in medical
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the da vinci robot has been used in more than 100 different kinds of surgical procedures.
John l. phillips, m.d.
First, Dr. Phillips moves aside
to a higher level.
the healthy surrounding tissues that
This robot isn’t the independent operator
normally cover and protect the kidneys
you see in sci-fi movies. named for the
such as the liver, spleen, colon, pancreas
Renaissance artist who first dreamed
or adrenal glands. Then, the major artery
up the concept of robots, the da Vinci
and vein to the patient’s kidneys must
surgical system instead replicates
be delicately controlled. These vessels
the surgeon’s own hand motions—but
deliver up to an eighth of each heart
with a dexterity and smoothness of
beat’s blood volume and so must be
motion beyond the capacity of any
carefully prepped and controlled with
human hand. The surgeon sits at a
fine clamps to prevent any bleeding
console in the operating room, while a
during tumor removal. In Cunningham’s
fiber-optic imaging system lets him or
case, the cyst was removed and placed
her view the surgical site on a three-
in a small plastic pouch in case any cyst
dimensional monitor that magnifies the
tissue proved to be cancerous.
area. The surgeon deftly controls the
“Removing the actual tumor is the
fluid movements of the robot’s four
easier part of a partial nephrectomy,”
“arms” as they maneuver microsurgical
says Dr. Phillips, who is also an associate
instruments within the “ports,” the
professor of urology at new York
small incisions through which surgical
Medical College. “More challenging is
instruments are introduced.
reconstructing the kidney as soon as possible so it works normally within a few
saving a kidney
minutes. The robot allows the surgeon
Dr. Phillips is one of only a handful of
to do these important steps quickly, with
urologists in the Hudson Valley who
precision, and under high magnification.”
employ this technology to remove tumors
Fortunately, Cunningham’s cyst
and masses from the kidneys, bladder
was not cancerous. After her partial
and adrenal glands. He turned to the da
nephrectomy on June 8, she spent two
Vinci robot for Cunningham’s procedure
nights at Westchester Medical Center.
because of its precision, dexterity and
Within two weeks, she was back to
exceptional visualization.
her job as a dental hygienist at the
“The challenging part of a partial
Yorktown Heights dental practice of
nephrectomy [‘kidney-sparing surgery’]
Mitchell l. Kahn, DDs. The remaining
is the surgical setup prior to the actual
portion of her right kidney is now
tumor removal,” explains Dr. Phillips,
functioning normally.
who has been performing this operation
“Besides being a brilliant surgeon,
laparoscopically since 1998 and
Dr. Phillips is a very special person who
robotically since 2003. “You can almost
treated me with true kindness,” says
liken it to the time nAsA devoted to
Cunningham. “This surgery was the right
preparing for a two-minute moon walk.”
treatment for me.”
sean s. tedjarati, m.d.
THE sURgICAl ROBOT:
one tool, many uses over the past seven years, Westchester medical center has built a robotic institute and training facility, headed by John l. phillips, m.d., to teach surgeons to use the da vinci surgical system and enhance clinical research in robotic procedures. sean s. tedjarati, m.d., m.p.h., who heads the division of gynecologic oncology and center for robotic gynecologic surgery, has introduced several robotic procedures to treat benign and malignant gynecologic conditions, including early endometrial, cervical and ovarian cancers. in urogynecology, which deals with disorders of the pelvic floor in women, division chief huansue zhou, m.d., uses the da vinci robot to perform a surgery called abdominal sacral colpexy. this is used to repair uterine prolapses, when the uterus sags or drops down into the vagina and causes urinary retention, constipation and/ or pelvic pain. “the beauty of the robot is that its superb 3-d visualization and the flexibility of its arms enable me to operate deep within the area called the vaginal vault without causing great harm to tiny blood vessels there,” says dr. zhou, also an assistant professor of obstetrics and gynecology at new york medical college.
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huan-sue zhou, m.d.
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We’ve created a medical center where people are treated like their lives depend on it.
Because they do.
Arthur Bartosch, BS, CBET, Director, Biomedical Engineering Services
At Westchester Medical Center, we set the standard in healthcare. You can see it in every room, every hallway and every department. You can see it in the eyes of a heart transplant patient or on the faces of parents whose newborn weighs just over a pound. Our advancements extend across the entire medical facility – from our innovative Maria Fareri Children’s Hospital to the latest technology, lifesaving procedures and top doctors, nurses and staff. This is how we’ve achieved national recognition for clinical excellence and have become the region’s premier destination for advanced care. So we’re ready when you need us most.
877•WMC•DOCS worldclassmedicine.com Maria Fareri Children’s Hospital • Heart Center • Cancer Institute • Transplant Center • Neuroscience Center Joel A. Halpern Regional Trauma Center • Burn Center • Behavioral Health Center
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