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SIUH’s Interventional Radiology team performs minimally invasive procedures to correct a range of health issues

By Jessica Jones-Gorman • Photos By Amessé Photography

More than 50 years ago, when the first angioplasty was performed and the first catheter-delivered stent was used to treat peripheral arterial disease, interventional radiology changed the landscape of modern medicine. It was a subspecialty still in its infancy, but the possibilities seemed endless. Now, after five decades of technological advances and research, interventional radiology treatments are helping women with uterine fibroids, treating previously inoperable cancers, and saving lives by removing dangerous blood clots.

“Interventional radiology treatments are minimally invasive procedures which make use of image guidance through a small incision where a catheter and wires are inserted,” noted Dr. Jonathan Scheiner, who serves as director of Interventional Radiology at Staten Island University Hospital (SIUH), which has a dedicated interventional radiology team.

“Within the past few years these treatments and image-guided therapies have been used to treat a lot of different cancers, to break up blood clots, and prevent stroke,” Dr. Scheiner said. “Innovations in this field have been substantial.”

And while the benefits of minimally invasive procedures have been evident for years (easier recovery for patients, lower surgical morbidity rates and possible alternative treatments for previously nonoperable candidates), its new and innovative treatments and techniques that are now the focus of this field.

“During a cancer treatment, we are now able to get direct access to a tumor with a small catheter inserted through the artery,” Dr. Scheiner said. “We can then inject chemotherapeutic agents or radiation directly into the tumor, treating the cancer without harming the surrounding tissue.”

Northwell A22 SPREAD

This nonsurgical treatment of tumors is just part of the modern face of interventional radiology. According to Scheiner, many other procedures are available, including embolization therapy to stop hemorrhaging or to block the blood supply to a tumor; catheter directed thrombolysis to clear blood clots within lungs, preventing disability from deep-vein thrombosis and stroke; and carotid artery angioplasty and stenting to prevent stroke.

“Interventional radiology is a field of constant change,” explained Scheiner. “Ninety percent of procedures I performed during my fellowship are not done anymore and have been replaced by more modern procedures. That’s why it’s important for doctors in this division to stay up to date, consistently exploring new and innovative techniques.”

At SIUH, the interventional radiology team includes four doctors, a nurse practitioner, a rotating resident, and a number of nurses and technicians. Each radiologist is capable of performing any procedure, but each one also focuses on particular areas of anatomy.

Dr. Scheiner, who graduated from the Albert Einstein College of Medicine in New York before completing a residency at Montefiore Medical Center and fellowships at Memorial Sloan Kettering Cancer Center and New York Hospital Weill Cornell Medical Center, concentrates on cases above the neck: carotid stenosis, intracranial thrombectomy, and other matters which can lead to stroke.

Dr. Christopher Giordano, who completed his residency and fellowship at Mount Sinai Hospital, has a special interest in procedures involving liver disease and was instrumental in bringing the radio embolization treatment Y90 to SIUH.

In this procedure, which combines embolization and radiation therapy to treat liver cancer, tiny glass or resin beads filled with the radioactive isotope yttrium Y90 are placed inside the blood vessels that feed a tumor.

Dr. Noor Ahmad, who has an undergraduate degree in biomedical engineering, performed his fellowships at New York Hospital Weill Cornell Medical Center and Memorial Sloan Kettering before joining the SIUH team in July. Well-rounded in all areas of interventional radiology, Dr. Ahmad actively works with the Northwell Team to promote uterine fibroid embolizations for women as an alternative to surgery.

Dr. David Geller, who comes from a family of radiologists, completed his residency at St. Barnabus Medical Center in Livingston, NJ, and a fellowship at Mount Sinai before focusing on urology procedures and biliary cases at SIUH.

“We work closely with the urology department and can treat chronic infection related to an indwelling foley catheter,” Dr. Geller said. “We also regularly perform percutaneous nephrostomy for the treatment of complex kidney stones.”

Debbra Monchik is a nurse practitioner whom Dr. Scheiner refers to as the “glue” of his radiology team, which handles about 2,800 cases each year. As “This is easily one of the best systems in the city,” Dr. Scheiner said. “It allows us to perform CT scans right on the table, in the midst of a procedure, which is a huge advantage.”

The division nurse practitioner, Monchik acts as the hub for everyone involved.

“My role is to keep our referring doctors, and most importantly, our patients satisfied and treated in a timely manner with the same expertise and knowledge that they would expect at any large city hospital,” Monchik said.

Efforts of the interventional radiology team were boosted this past July when SIUH unveiled a biplane angiography suite, which features the most current imaging modality for visualization of complex cerebral and peripheral vasculature. With faster image acquisition, biplane technology represents an improvement over single-plane angiography systems and enables the performance of neuro interventional procedures.

“This is easily one of the best systems in the city,” Dr. Scheiner said. “It allows us to perform CT scans right on the table, in the midst of a procedure, which is a huge advantage.”

And, according to Scheiner, it’s just part of the high-tech advances in store for interventional radiology.

“In the future I think more and more general procedures traditionally treated with large surgeries will move over into the minimally invasive realm,” he added. “Gastric artery embolization is showing a lot of promise in the treatment of obesity—it’s a surgery similar to gastric bypass but it’s being done through the artery, which is closed off, and results in a decrease in hunger for a lot of patients. There’s also a lot of research being conducted on procedures in men with an enlarged prostate. It’s also based on the same premise—an artery is closed off which in turn helps shrink the enlargement.”

For patients, these developments are major.

“Minimally invasive procedures only require light anesthesia—a sort of twilight medicine—so patients don’t have to go through the ordeal of general anesthesia,” Dr. Scheiner concluded. “And there isn’t a lot of discomfort. We’re usually going through a radial artery, so they are able to get up and move immediately after the procedure. The results are decreased hospital stays, lower costs, and more comfort for the patient. They can get back to their daily activities right away…and that’s our job, to solve our patients’ health problems and help them return to a healthy life.”

SIUH Interventional Radiology
475 Seaview Avenue / 718.226.9000 / siuh.edu