Ultimate Precision
(l-r) Director of Radiation Oncology David Schwartz, MD, DABR ; Lawrence Pesce, RTT; Michael Atala, RTT; Paola Bongiovi, CMD; Matthew Worth, MS, DABR; Henry Volmar; Rene Brito, CMD; Andrea Borsic, RTT; Nadar Girgis, RTT; Aleksey Polubarov, CMD; Roberta Ashenfarb, RN; David Schreiber, MD, DABR; Cristina Fanita, RTT; Carol Scara, RTT; Ramez Morkos, Chief Therapist/A.O; and Dalia Awawdeh, MSA.
Radiation Oncology Services at VA New York Harbor has dramatically improved the efficiency, precision, and scope of service for radiation treatment after their acquisition of the Varian TrueBeam STx linear accelerator. The Varian True Beam STx linear accelerator delivers radiation with the highest precision to patients, with the capability to deliver everything from standard radiation therapy to complicated Stereotactic Radiosurgery. Currently, Stereotactic Radiosurgery is performed on certain tumors involving the brain, prostate, spine, liver, and lung.
As the field continues to progress, many patients who in the past required standard treatment courses, are now treated with Stereotactic Radiosurgery – requiring between 1 and 5 days, instead of multiple weeks of treatment. Director of Radiation Oncology Dr. David Schwartz, who works as a team with Dr. David Schreiber, is enormously enthusiastic about the new techniques being utilized to treat VA New York Harbor cancer patients.
Patients are treated with the intent of maximizing dosage to cancer tissues and minimizing doses to normal surrounding tissues. After the initial patient consultation, the radiation oncologist (with input from medical oncologists, surgeons, urologists, and radiologists) decides how the patient should be treated. The radiation therapist conducts a planning CT scan of the treatment site and surrounding anatomy. In conjunction with other imaging studies such as PET/CT and MRI, the Radiation Oncologist reviews the planning CT with members of the physics department to outline the tumor/regions that need treatment and organs/regions that need to be avoided.
Using computer based planning, our dosimetrists, Aleksey Polubarov and Rene Brito, design a treatment plan instructing the linear accelerator how to direct beams of external radiation, allowing for maximal tumor dose and minimal normal tissue dose. Once the plan is approved by the physician, it is the responsibility of our chief medical physicist, Matthew Worth, to perform the necessary quality assurance and approve the plan for treatment.
The process ends with the radiation therapist doing one final qualitative check of the plan and treating the patients. Chief Radiation Therapist/AO, Ramez Morkos, along with Head Nurse Roberta Ashenfarb, works with the patients to ensure their maximum comfort level throughout the treatment, including coordinating their time of treatments, minimizing wait times and ensuring seamless integration with our medical oncology colleagues. The steps followed provide multiple levels of quality assurance to assure accuracy of dose treatment prior to delivery, while maintaining the support and care for our Veteran patients.
For the majority of daily radiation treatments, a cone beam CT (which is a CT scan generated by our TrueBeam STx) is taken. This cone beam CT scan is superimposed on the treatment planning CT scan and patient positioning is adjusted to ensure the accuracy of radiation delivery to the treatment region. Such image guidance allows for lower toxicity to normal tissue and higher tumor doses. It is state of the art.
In addition to cutting edge linear accelerator treatments, VA New York Harbor provides patients with prostate cancer the important option of prostate seed implantation, also known as Prostate LDR Brachytherapy. An invasive procedure requiring the implantation of radioactive seeds in the prostate, this operating room procedure allows the patients, particularly those from further away, the ability to have treatment completed within a single day in the hospital. The VA New York Harbor is one of only 7 VA hospitals in the country which perform prostate brachytherapy. The technique utilized by VA New York Harbor provides for extreme accuracy, allowing for thorough coverage of the prostate with sparing of high doses to surrounding normal tissues.
VA New York Harbor’s Radiation Oncology Department is academically prolific and an important rotation for SUNY Downstate radiation oncology residents. Dr. Schreiber (Director of Clinical Research for the residency program) and Dr. Schwartz have authored many publications which have been accepted to peer review academic journals.
