Tools of the Trade
You tote an iPod, a BlackBerry, a Kindle, and a netbook. You have a garage filled with enough tools and gadgets to tackle every household chore. And you secretly think maybe you were born too soon, because you would love to see what science and technology have in store 100 years from now. We get it—we love our tools, too. At Overlook, our commitment to care means keeping in step with the latest and greatest tools and technologies. Our cutting-edge equipment may look and sound like props from science-fiction movies, but are in fact the most elite medical devices for providing our community with unparalleled care.

By Alyson Black

CYBERKNIFE

When CyberKnife was introduced to Overlook five years ago, doctors and cancer patients were eager to see if it could deliver on its promise: noninvasive, highly accurate, and painless treatment of cancer in various parts of the body, without any incisions or blood and virtually no recovery time. Today, hundreds of patients are living longer, stronger, better lives as a direct result of CyberKnife, a revolutionary radiosurgical device that combines robotics and image-guidance technology to deliver precisely targeted doses of radiation to tumors—even tumors that are considered inoperable by conventional or other stereotactic radiosurgical methods. Treatment is usually done on an outpatient basis—and because it truly is painless and noninvasive, there are fewer complications and patients are able to return to their normal activities right away. Currently, CyberKnife is being used in the treatment of tumors and lesions in the brain, spine, lung, liver, pancreas, and prostate, and can be used in conjunction with chemotherapy and general external radiation when necessary.

C-PORT-E

Do patients who undergo elective angioplasty fare as well at hospitals with cardiac surgery on-site versus hospitals that have off-site cardiac surgery back-up? That’s the question being asked by the Cardiovascular Patient Outcomes Research Team (or C-PORT), an ongoing study spearheaded by Johns Hopkins Medicine and carried out by a consortium of nine hospitals in New Jersey, including Overlook.

“The hypothesis is that it is safe,” says Steven Sheris, MD, FACC, chief of cardiology at Overlook and a member of Associates in Cardiovascular Disease. “So a procedure at Overlook would not be considered inferior to the same procedure performed in a hospital with onsite heart surgery.” The C-PORT-E study will eventually include 18,000 patients. Patients are randomized three to one to have the procedure done at Overlook, versus transfer to a hospital with surgery on site. At Overlook, where the study is led by Director of Cardiac Catheterization Daniel Schwartz, MD, most patients are referred into the clinical trial when they are hospitalized with a heart attack and they consent to catheterization in the hospital, or they are enrolled by a cardiologist’s office when they have been selected to possibly have angioplasty as an outpatient.
Angioplasty, explains Sheris, has a long track record of success in the treatment of heart attacks, and elective angioplasty—the type highlighted in the study—reduces cardiac symptoms and may reduce the likelihood of heart attacks. The procedure is performed under local anesthesia by an interventional cardiologist who threads a catheter to the heart and injects dye to locate any blockages; a tiny balloon is then inflated and a stent is used to widen a blocked artery narrowed from the buildup of cholesterol-laden plaque. “Elective angioplasty applies to a different patient population,” says Sheris. “Patients who are having a heart attack have a time-sensitive need to have their artery opened ASAP, preferably within 90 minutes of arrival at the hospital. The elective angioplasty procedure is not the same, but just as critical. Two-thirds of patients have ‘incomplete’ heart attacks, in that they do not have a totally occluded artery but are at an increased risk for future events. These patients deserve considerable attention. They still need therapy in an expeditious manner.”

To that end, the results of the C-PORT-E study—if they support the hypothesis, as expected—will mean that expanding the number of sites able to perform elective angioplasty will allow patients to remain in the continuous care of their own trusted primary care physician and cardiologist, and ultimately lead to increased treatment—and improved access to care without compromise in safety.

ACQUILION ONE

Al Kerestes, manager of radiology services at Overlook Hospital and Overlook’s Union campus, describes Toshiba’s Acquilion One as “a quantum leap in CT technology.” Introduced to the hospital in May, the Acquilion One is a high-speed CT scanner that covers as much as four times more surface area in a single image than any other commercially available CT—with just a fraction of the radiation exposure. With a rotation speed of just one-third of a second, the Acquilion One can scan the entire body in less than a minute, but it is particularly useful in capturing the brain and the heart—organs that require high-speed imaging because either the circulatory dynamics or the organ itself are constantly in motion.

The unit’s lightning-fast speed and unmatched clarity are especially beneficial in the diagnosis and treatment of stroke, as images now can be acquired, processed, and read by a radiologist within 20 minutes. “Time is brain,” says Kerestes. “The faster we can diagnose and treat patients, the better able we are to generate more-positive outcomes.”

Currently, Overlook’s Acquilion One is one of only three such units on the eastern seaboard and the only one in the metropolitan area. “Overlook has always been a leader in terms of its commitment to quality imaging and decreasing radiation doses,” says Kerestes. “Several years ago, we put a program in place to reduce radiation doses, with a special focus on pediatric patients. Bringing in equipment like the Acquilion One represents a continuation of our commitment to that process. This product provides cutting-edge imaging capabilities with enhanced patient safety. That’s what drives us here at Overlook.”

BIPLANE ANGIOGRAPHIC UNIT

Siemens’ Biplane Angiographic System is an X-ray fluoroscopic unit that looks inside the human body from multiple angles, meaning that views are virtually unlimited. The focus here is on circulatory dynamics, which is key in diagnosing and treating vascular disorders, particularly those that are neurologically based. In treating aneurysms and strokes, for example, it is necessary for an interventional neurosurgeon to pinpoint the location of an abnormality, so that it can be more easily remedied. The device is critical in that process and is also helpful in carrying out stenting procedures, as well as correcting other circulatory abnormalities.

MERCI RETRIEVER & PENUMBRA DEVICE

“We’re evolving the way stroke patients are treated,” says Kerestes. The Merci Retriever and Penumbra device represent two different tools that may be deployed to physically remove a clot that is obstructing blood flow to a portion of the brain. Both tools utilize biplane angiographic devices to pinpoint clots. The Merci works by threading a corkscrew-like wire through a catheter to ensnare the clot, while Penumbra is deployed in a similar fashion but utilizes suction to remove the clot. Overlook was the first hospital in New Jersey to utilize this technology. To date, approximately 250 patients have been treated with the Merci Retriever, and another 50 have been treated by Penumbra. “We have one of the largest treatment bases in the United States,” says Kerestes. “And we have the highest rates of intervention with stroke patients, too.” With technologies like these, it’s no wonder more than 20 hospitals throughout New Jersey refer their patients to Overlook for advanced treatment options.

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For more information on CyberKnife or other radiological services, call (800) 247-9580.