The Latest Medical Advancements In Our Own Back Yard

By+Kelli Stopczynski

It seems we always hear about new technologies that are improving the quality of heath care at lightning speed. It might also seem like those new procedures are only available in big cities—Chicago, Indianapolis or even further away than that. But you might be surprised to learn local physicians and the facilities where they work are doing everything they can to stay at the forefront of medical advancements so you can receive those same cutting edge treatments much closer to home.

ADVANCEMENT: NUCLEAR CAMERA
Memorial Hospital

Perhaps one of the most important facets to staying on the cutting edge of medical technology is not only learning about the “latest and greatest” equipment and procedures on the market, but also understanding how those procedures and equipment will affect patients. Newer, noninvasive imagery techniques and the type of care provided for each patient are just two of several areas where the team of cardiologists inside Memorial Hospital’s Advanced Cardiovascular Institute prides itself on having expertise in cardiac diagnostics and procedures normally seen in academic teaching hospitals.

A new piece of equipment arriving at Memorial Hospital this spring is a nuclear camera—a device that has higher accuracy in detecting blockages to the heart using a lower radiation dose than any other type of camera. Normally a patient who has to undergo nuclear stress testing has to lie down on a table for 30 to 40 minutes at a time with minimal movement. The entire test takes three to four hours. The nuclear camera cuts that time down to about eight to ten minutes lying down and a total test time of about one hour. “This camera will be unique to the area and at this time it is not even available in Chicago. Mayo Clinic and a few other high-end hospitals are currently using this in the United States,” said cardiologist Breno Pessanha, MD.

The nuclear camera will also significantly decrease the amount of radiation received by patients, ultimately making it safer. Cardiology experts at Memorial say research shows radiation is cumulative, and each time you are exposed to it you increase your risk of getting cancer.

“One of the things that is really important to us, is just because you can do a test or a procedure doesn’t mean it is without risk,” explained Advanced Cardiovascular Institute Medical Director and cardiologist Raman Mitra, MD, PhD.  “People think nothing of having a CAT scan, but in your life if you have three or four CAT scans you’ve already increased your risk of cancer when you’re in your 50s and 60s.”

Another example of life-saving expertise at Memorial’s Advanced Cardiovascular Institute is the physicians’ training in cutting-edge technologies. Dr. Pessanha underwent extensive training at Duke University in order to be able to read LEVEL II cardiac MRIs. He put that training to use when one patient came to Memorial after visiting multiple doctors who could not diagnose the problem. This patient had recurrent swelling of her abdomen and legs for several months due to accumulation of fluid. She needed to have the fluid drained from her abdomen every few weeks with a needle, which was a temporary solution rather than curing the underlying problem.  

Dr. Pessanha worked in conjunction with the Radiology department and discovered her heart was over-filling due to hardening of the outer layer of the heart. That discovery helped doctors properly treat the patient’s problem by submitting her to a much needed surgical procedure at Memorial hospital. 

“Based on the technology and the expertise of Dr. Pessanha, he was able to accurately diagnose what the problem was and she was completely cured,” explained cardiologist Shakil Aslam, MD.

The cardiologists at Memorial believe they are different from other area groups because of the type of care they provide. 

“If a patient comes in our practice, we can provide complete care in any of the fields of cardiology without sending the patient to different offices and hospitals,” said Dr. Aslam.

An example is a patient who needs an endovascular stent graft for aneurysm or stent in the carotid artery or closure of an Atrial Septal Defect (“hole in the heart”). In the past he might need to see several doctors in different offices to get the tests for cardiac clearance and finally to undergo the surgery. Now, Memorial Advanced Cardiovascular Institute has all those physicians on-site who can not only prepare the patient for surgery, but also perform the surgery and treat risk factors like high cholesterol and hypertension. This will help prevent blockages from coming back or even developing in the first place.

ADVANCEMENT: RAPIDARC
Elkhart General Hospital

Elkhart General Hospital is the only hospital in Northern Indiana to offer cancer patients RapidArc™ technology.  RapidArc delivers radiation faster and more precisely than any other technology available today, according to Brion Shin, MD, a Radiation Oncologist at Michiana Hematology-Oncology, PC, and member of the Elkhart General Hospital Medical Staff. It is the latest generation of Intensity- Modulated Radiation Therapy (IMRT), a technology that enables individual radiation beams to conform to the shape of the tumor. 

“Our goal is to cover the tumor and a margin of error with radiation in order to eradicate the cancer cells we can see, as well as those we can’t see,” said Dr. Shin. “RapidArc allows us to modulate the intensity of each beam to give the maximum dose to the tumor and the minimum dose
to the surrounding tissue.”

RapidArc treatment lasts less than two minutes and is currently used to treat prostate cancer and tumors in the head and neck, where protecting delicate structures are a major concern. Using RapidArc to treat tumors in the lung and other locations is next on Elkhart General’s agenda.

IMRT has improved the amount of radiation delivered to cancer cells while protecting healthy tissue and sensitive organs lying in the beams’ path. Before the patient’s first treatment, a team lead by a physicist creates an individual treatment plan using the patient’s X-rays and CT scans. The team identifies organs to avoid and decides how the radiation will come out of the machine at every angle.

Treatment with RapidArc is much faster than with IMRT. RapidArc’s radiation-delivering arm rotates 360 degrees around the patient in less than two minutes—much faster than the 10-15 minutes required by IMRT.

“When you reduce treatment time, there is less opportunity for geographic misses. Less radiation to normal tissue decreases the risk of side effects,” says Dr. Shin.

In the near future, Dr. Shin hopes to use RapidArc’s precision technology to perform stereotactic radiosurgery—a form of treatment where several high doses of focused, precise radiation are given to eradicate a tumor. The technique can be used on a single brain tumor or single lesion in the lung of patients who are not candidates for surgery.

ADVANCEMENT: LAPROSCOPIC TECHNOLOGY
South Bend Orthopaedics

You might not think about your musculoskeletal system very much on a day-to-day basis but that intricate system of bones, joints, ligaments, tendons, muscles and nerves is integral to your survival. At some point in our lives we’ll all likely experience some sort of injury or malfunction within the musculoskeletal system—a broken arm or leg or a hip or knee joint in need of replacement. Did you know one of the largest orthopaedics groups in the state of Indiana is in your back yard? 

Part of South Bend Orthopaedics’ commitment to staying on the forefront of medical advancements is also seizing opportunities to bring new types of care that aren’t already offered in the South Bend area, said orthopaedic surgeon and President of South Bend Orthopaedics Michael Kelbel, MD.

In 2009, South Bend Orthopaedics founded South Bend Spine. Together, the two facets of the 19 physician practice specialize in shoulder, elbow, hand, foot and ankle, hip and knee problems, trauma care and back and neck pain.

There’s a good chance you or someone you know have suffered from a neck or back injury. The area around the spine is a sensitive one and without proper treatment, those types of injuries can be debilitating.

“I think in our society we can sprain any other part of our body and we’ve been taught to walk it off or give it time so it will get better. However the minute somebody tweaks their back, they are afraid they are injured for life,” explained South Bend Orthopaedics spine specialist Thomas Mango, MD. “The truth is that most injuries improve with proper treatment and that doesn’t necessarily need to be surgical intervention.”

Dr. Mango said the art of his job is figuring out whether a patient suffering from a spinal injury needs surgery or an alternate form of treatment. Even though he believes spine surgery should be the last option to explore, Dr. Mango said technological advancements make what used to be a very extensive surgery now minimally invasive.

One example, a disc laminectomy—a surgical procedure used to remove or reshape part of a herniated disc that may be causing leg or back pain—used to require a five to six inch incision. Laproscopic technology now allows surgeons to see live images of the disc on a screen in the operating room, bringing those incisions down to 18 millimeters.

Smaller incisions mean smaller scars, less damage to tissues and muscles, less post-operative pain and quicker return to activity—benefits both patients and physicians are embracing as they journey into the exciting and ever-evolving future of orthopaedic medicine. 

ADVANCEMENT: IMAGE GUIDED RADIATION THERAPY
Goshen Center for Cancer Care

“We’re always looking for new technology not just for the sake of being new, but technology that is advanced in the care of patients,” explained medical director and surgical oncologist Doug Schwartzentruber, MD, FACS.  

Some of the most expansive technology that is rapidly changing has to do with radiation technology. Recently, Goshen Center for Cancer Care became the second in the state to bring in Image Guided Radiation Therapy (IGRT)—a tool that allows physicians to ensure radiation treatment is delivered precisely.  

“Before the IGRT, we had no way to verify that indeed the radiation treatments were going exactly where they were supposed to,” Dr. Schwartzentruber said.  “But now we do.”

Radiation technology has advanced so much in recent years that some prostate and breast cancer patients at Goshen Center for Cancer Care actually have a chip inside of them that can prove how much radiation was received at that given location.

The Center is also dedicated to research, allowing its patients cutting edge treatment options on a clinical trial basis before those treatments are approved by the Food and Drug Administration (FDA).

“This is a very important topic for many patients these days because oncology is developing very rapidly,” explained medical oncologist Alexander Starodub, MD, PhD. “The reason many patients used to go to major medical centers was so they could have access to that experimental research protocol. Now our goal is to bring as many of the new protocols as possible here.”

Goshen Center for Cancer Care won a national award for its integrated care model. Through that model, all 11 physicians on staff meet several times each week to discuss each patient’s case and what might be the best plan for treating that patient. Those discussions include medical oncologists, radiologists, surgeons and naturopathic physicians. Naturopathic physicians are certified after four years of medical schooling (beyond an undergraduate degree) where they learn eastern medicine techniques such as acupuncture therapy and other alternative treatments.

The integrated care model also ensures patients meet with counselors, spiritual leaders, social workers and dietitians.  Dr. Schwartzentruber believes the model is one reason the Center draws about 20 percent of its patients from beyond Indiana’s borders—including Texas, Ohio and even the Netherlands.

“It never replaces what we do with our medical therapies and interventions. It compliments them,” he explained.  “Cancer is a tough battle. You’ve gotta tackle it from every angle possible so we use evidence-based practices from every angle possible.”

ADVANCEMENT: SINGLE PHOTO EMISSION COMPUTED TOMOGRAPHY
St. Joseph Regional Medical Center

Gone are the days of heading to the radiologist for an X-ray then waiting hours or even a couple days to find out the results. Just as we’ve seen our point and shoot cameras go from 35 millimeter film that had to be developed in a dark room over a period of time to digital images we can see within seconds of snapping a photo, X-ray technology has also evolved. 

“The transition to digital imaging is showing the radiologist the picture within minutes of it being acquired. It’s a huge difference. We used to rely on paper,” said Dave Hofstra, Saint Joseph Regional Medical Center’s Director of Diagnostic Imaging. “I think a great majority of our cases are being read within two hours and transcribed in a matter of 15 minutes. Since the images are stored digitally, emergency physicians can see the images right after they’re taken—it’s a pretty new world compared to even five years ago.” 

The old film cassette that used to be developed into an X-ray image is now a mobile digital plate. The new images can now be checked without removing the digital plate from underneath the patient. The patient experiences much less discomfort than the old way of having to remove and replace a cassette for each image and then check them. And just as a photographer can lighten, darken, rotate or flip a digital picture, the same can be done with digital X-rays.

Another piece of digital imaging equipment Hofstra maintains, SJRMC has exclusively in Northern Indiana and Southwest Michigan, is a nuclear medicine camera that combines with CT. This combine technology scanner gives experts a clearer 3-dimensional picture of internal organs such as the heart, bones and liver.

The Single Photon Emission Computed Tomography (SPECT/CT) machine works after radioactive dye is injected into a patient so physicians can see where it goes inside the body.  Using both the dye substance inside your body and the SPECT/CT images, doctors can determine whether certain parts of your heart are receiving adequate blood flow as they should be. Hofstra said other medical facilities in our area have similar nuclear medicine cameras that image patients’ hearts, but SJRMC has CT scanners added to two nuclear medicine scanners that allow doctors a much more accurate view inside a person’s body.

He compares the nuclear camera that includes CT to the radar images used in weather forecasting. The nuclear camera is similar to the radar picture of the storm and the CT portion is similar to overlaying the map of Northern Indiana and Southwest Michigan with that radar image, so you can tell exactly where the storm is located.

“I’m in a unique situation here. No expense was spared in my whole department when we built this new hospital,” he explained. “We were well ahead of the ballgame in purchasing those cameras.”











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