WMC - Imaging 2010

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

2 W e lco m e

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

We stchester Medical Ce nter 1-877-WMC-DOCS | www.worldclassmedicine.com

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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.

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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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WMC_Imaging_1010final.indd 15

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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