Cutting-edge technology improves efficiency and patient outcomes.
by Bob Kronemyer
Whether it is being diagnosed or treated with the latest imaging system or laser, patients served by area hospitals are increasingly using cutting-edge technology that exists in their own backyard, rather than traveling to Chicago or Indianapolis.
Cardiac, cancer and sinus disorders are just some of the medical issues benefiting from new equipment and procedures. Hospitals also are becoming more efficient and convenient by embracing electronic patient health and medical recordkeeping.
The use of technology in health care helps improve treatment, says Dr. Alexander Stemer, president and CEO of Medical Specialists in Munster, explaining that the organization started using advanced scanning, ultrasound and diagnostic technology before it was considered standard medical practice.
“Medical Specialists places the technology directly in the care environment, making the best care also the most convenient care,” says Stemer. “For example, our Center for the Management of Diabetes Mellitus had advanced equipment for dilated retinal photography and equipment to accurately measure blood flow to the feet in the same office in which our diabetic patients are treated.
“Our pulmonary office is fully equipped with the most modern lung function testing equipment,” says Stemer. “Our dermatology offices have fully equipped laboratory services to process our skin cancer slides while Mohs skin cancer surgery is being performed.”
In addition, Stemer says Medical Specialists is immersed in electronic recordkeeping as a way to provide better health care and better interaction with patients.
Franciscan Alliance
One of many cutting-edge procedures being practiced in the region is balloon sinuplasty, an endoscopic surgical technique that can restore normal sinus function. Sinuses are spaces within the bones of the skull that directly connect with the nose. In turn, that directly connects with the back of the throat and any disturbance of sinus function can lead to an infection called sinusitis, characterized by headache, fever or pain.
“Sinus problems are a widespread ailment,” says Matthew Teolis, D.O., vice president of medical affairs at Franciscan St. Margaret Health, one of Mishawaka-based Franciscan Alliance's 14 hospitals in Indiana and Illinois. In Northwest Indiana, locations are in Hammond, Dyer, Michigan City and Crown Point.
“These spaces within the skull bones can become disturbed in their function–irritated and inflamed. These spaces are also lined with the same kind of tissue found in the mouth and the nose. When such tissues become inflamed, they swell up and prevent the normal passage of both air and mucus through these spaces in the bone. Balloon sinuplasty can help.”
This outpatient procedure typically takes about one hour. “Instead of lifting up the upper lip and cutting a hole into the sinus–over the gum line and teeth–to drain the mucus, we now can use a small balloon catheter or tube that is inserted into the nose,” says Teolis. “The balloon catheter is then threaded into the sinus and inflated to widen the sinus passageway. This increase in size allows for more normal flow of air and mucus in and out of these cavities in the skull.”
With proper patient selection, about 80 percent of people become symptom-free within two years.
For bariatric surgery for morbidly obese patients, Franciscan Alliance offers a variety of minimally invasive endoscopic procedures that limit the size of the stomach and its ability to hold food.
“The bypass procedure reconstructs the stomach and flow of food through it,” says Teolis, whereas the sleeve procedure employs an innovative instrument that allows for removal of some stomach tissue with application of an epoxy. Likewise, the banding procedure involves placement of an adjustable band across the upper part of the stomach to create a smaller “container” for a meal. “All of these procedures are carried out by way of the endoscope and require only a small incision,” Teolis says.
IU Health LaPorte Hospital
Sensei (from Hansen Medical) is a robotic catheter-guided system for treating abnormal heart rhythms at Indiana University Health LaPorte Hospital. This catheter ablation, which can take from two to eight hours, selectively destroys areas of the heart that cause an irregular heartbeat.
Using a joystick and watching a three-dimensional image on a monitor in a control room adjacent to the procedure room, the cardiac electrophysiologist “places the catheter in the patient's heart, then uses the robotic arm to position and maintain the contact with the tissue inside the heart,” says Chris Atherton, a registered nurse and director of EP (electrophysiology) Services at the hospital.
The catheter uses either a heated radiofrequency (RF) energy tip or a cool saline-irrigation tip, depending on the heart rhythm and location. “Tissue is either burned or cooled down for destruction, so impulses can no longer pass through that area of the heart,” Atherton says. “Hence, patients no longer have an irregular heartbeat.”
The 227-bed LaPorte hospital has been offering Sensei since May. The success rate is high, according to Atherton, who notes that before Sensei, similar procedures relied on greater exposure to x-rays, as physicians and staff navigated the catheter internally. Also, the overall procedure time was longer with the older technology.
Physician fatigue is also reduced with Sensei because the operator no longer has to hold and move the catheter with his hands for hours on end at the patient's bedside. No longer having to wear heavy lead protection against x-ray exposure is another advantage. “Doctors much prefer using a simple joystick, which is similar to those used in a video game,” Atherton says.
Memorial Hospital
At the 350-bed Memorial Hospital and Health System in South Bend, going paperless continues with the ongoing implementation of electronic health records. In July, physicians in the emergency department started electronically inputting their own orders; in November the remaining doctors hospital-wide are scheduled to follow suit.
“Orders previously written on a piece of paper will now be placed directly into a computer,” says chief medical information officer Dr. Ken Elek. “This change gets rid of the interpretive step, whereby the doctor writes an order long hand but someone else has to figure out exactly what the doctor meant.” Hence, time is saved and accuracy ensured.
With this progression in electronic recordkeeping, any location where a staff member can access the Internet “will also connect to our network and then allow that person to view whatever needs to be viewed in a particular patient's record,” says Elek.
Moreover, the hospital has invested in lightweight, portable tablets with long battery life (an entire day) to retrieve patient records. “No longer do you need to carry around an eight-pound laptop,” says Elek.
Memorial Hospital also now has two da Vinci Surgical Systems for robotic-assisted minimally invasive surgery, such as for prostate and ear, nose and throat (ENT). “The nerves that travel through the prostate are very complicated,” Elek says. “Severing too many of these nerves can lead to impotence or incontinence. Using the da Vinci allows these nerves to be spared by greatly magnifying the area, while removing the necessary prostate tissue associated with cancer.”
Similarly, ENT procedures are suitable for da Vinci because of the confined area. “Instead of making a large incision for a human hand, small instruments can be precisely inserted through the mouth or nose using the robotic arm,” says Elek.
Elkhart General Hospital
The recent alliance of Memorial Hospital and Elkhart General Hospital will allow the two institutions to share cutting-edge technology. The two-hospital system also will “allow for better facilities and upgraded technology,” according to an announcement from Elkhart General Hospital.
Some of that cutting-edge technology is being installed, says Dr. Samir Patel, a diagnostic radiologist at Elkhart General. A low-dose CT scanner manufactured by Siemens Medical is scheduled to go online by the end of November.
“It follows the lean enterprise theory of operation of doing more with less,” says Patel, who has been with Elkhart General for 10 years. “The more is the sophisticated diagnosis of ailments like coronary artery disease that the new scanner allows us. It also improves the speed of our diagnosis.
“The less is an across-the-board reduction in radiation levels for all diagnoses,” says Patel. “We're getting the same or more information with less radiation. That's good for our patients.”
He compares the upgrade in technology with purchasing a more fuel-efficient car. “You're able to drive that car more miles while using less gas. With this, we're able to use the CT scanner for more things with less radiation. With this new scanner I can get more information with less gasoline.”
At the same time the new machinery is being installed, Patel says Elkhart General is upgrading the efficiency of its existing CT scanners.
“All of our scanners are from Siemens and they're all efficient, but the new one has some additional bells and whistles the old ones don't. This is a significant technological upgrade, and for Elkhart General, it keeps us as a leader in the use of imaging technology in northern Indiana.”
Community Healthcare System
Patients with brain, lung or spine cancer can benefit greatly from external beam radiation applied by the CyberKnife Robotic Radiosurgery System at Munster-based Community Healthcare System.
“The CyberKnife system uses a variety of mapping and aiming techniques to deliver radiation extremely precisely, typically to small targets that are normally hard to reach,” says Dr. Andrej Zajac, a radiation oncologist and medical director of the CyberKnife Center at St. Catherine Hospital. It is one of three hospitals in the system, which has a combined 600 beds. The others are Community Hospital in Munster and St. Mary Medical Center in Hobart.
Lesions in the brain–from primary cancer or more commonly from metastatic cancers that have spread to the brain from other organs–are particularly well suited for treatment with the CyberKnife, which relies on a stereotactic (three-dimensional) approach. With it, “an exact point in space is identified and specifically targeted,” says Zajac.
The daily, noninvasive therapy normally involves one to five sessions, compared to daily conventional external radiation therapy that takes anywhere from four to eight weeks. Side effects (most notably fatigue) are also lessened with the CyberKnife, occurring one to two weeks after completion of treatment.
“The CyberKnife is a significant advance in the art and science of radiation therapy in general,” Zajac says. “In many circumstances, outcomes are better than with conventional radiation therapy.”
Methodist Hospitals
Equally impressive is a new three-dimensional breast mammography imaging system at Methodist Hospitals for its Merrillville and Gary campuses. Combined, the two hospitals have 600 beds.
The system replaces two-dimensional scans, providing greater detail. “This three-dimensional system takes images of the breast at various angles. The images are then transferred to a series of 1 millimeter slices that can actually be viewed on a screen as a three-dimensional reconstruction of the entire breast,” says CEO Ian McFadden. As a result, “you can detect more abnormalities of the breast than may be undetected with two-dimensional imaging.”
Patients also avoid having to return for a follow-up mammogram to determine if the abnormality is benign or malignant. Furthermore, the three-dimensional system “will decrease the number of breast biopsies,” McFadden says.
Another three-dimensional technology to benefit cardiac patients since early this year is optical coherence tomography (OCT), which allows cardiologists to see inside the arteries with an infrared light source. “OCT replaces older imaging technologies like fluoroscopy and intravascular ultrasound,” McFadden says.
Methodist Hospitals also is building a new spine and orthopedic center in Gary, which will feature a navigational operating room system.
“Think of it as a GPS (global positioning system) in the OR,” McFadden says. Infrared cameras and tracking software help surgeons navigate the human body to the exact anatomical location where the procedure is to occur.
“Incisions will be much smaller, radiation exposure will decrease and surgeon error will be reduced,” says McFadden of the new center scheduled to open by the end of the year.
Porter Hospital
A new treatment option for patients with peripheral artery disease (PAD), a common circulatory disorder, has recently been employed at the 300-bed Porter Hospital and Health System in Valparaiso. Laser atherectomy uses a cool laser to vaporize blockages inside the artery and restore blood flow to the surrounding tissue.
The best candidates for the laser procedure are those who have a total obstruction of the peripheral artery, who develop lesions as a result of an implanted stent, or who experience a failed stent or a bypass graft that has become obstructed by a clot of blood.
Porter Hospital, which is being replaced with a new 250-bed (all private room) facility scheduled to open next fall, also has a new treatment option for patients with inoperable liver cancer. Selective internal radiation therapy (SIRT) is a minimally invasive, outpatient procedure that uses millions of microscopic radioactive spheres (SIR-Spheres) to target liver tumors in patients with metastatic liver cancer that originated in the colon or rectum.
SIRT is considered a safer and more effective method of destroying cancer than conventional radiation. The radiation is delivered via a catheter placed in the femoral artery of the upper thigh. Tiny radioactive beads enter the blood vessels that lead directly to the site of the tumor.
