Al Pha Sights - Baystate Health

Volume 20, Number 3 / Fall 2010
AlphaSights
A look at tomorrow’s health care today at Baystate Medical Center
Craniofacial Reconstruction
Stereotactic Body Radiation Therapy
Pediatric Radiology
Radioactive Seed Localization

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Volume 20 Number 3
Table of
Contents
Cover photo: Breast cancer cells
AlphaSights
Editors:
Suzanne B. Hendery
Trish Perrault
Managing Editor:
Suzanne Spiry
Writing:
Scott P. Edwards
Suzanne Spiry
Design:
Karen Beckstead
Photography:
Todd Lajoie
Kent Spiry
Chris Szarek
Printing:
Andrews Connecticut
Read current and archived issues of AlphaSights
magazine online at baystatehealth.org/alphasights.
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Craniofacial Reconstruction
A successful collaboration between
plastic surgery, neurosurgery, and
other specialties allows children with
craniosynotosis and other anomalies
to benefit from simultaneous reconstruction
of the head and face.
2 6
10 14
6
Stereotactic Body Radiation
Therapy
A new technology with roots in treating
brain cancer now offers an avenue of
hope for patients with inoperable but
early-stage lung cancer.
10
Pediatric Radiology
Baystate Children’s Hospital offers
specialized imaging services for
neonates, infants, children, adolescents,
and young adults that are supervised,
performed, and interpreted by
radiologists with subspecialty training.
14
Radioactive Seed Localization
Surgical specialists from Baystate’s
Comprehensive Breast Center now
offer an alternative to wire localization
to more precisely locate and remove
affected breast tissue during a
lumpectomy.
17
Welcome New Physicians
22
Honors & Announcements
24
Continuing Education
Calendar
Medical & Nursing Positions
Published by the Marketing & Communications Department, Baystate Health, Springfield, Massachusetts.
Editorial offices are at 280 Chestnut Street, Springfield, MA 01199. Telephone: 413-794-7652.
Submit article suggestions and address all communications to the Editors.
This publication was developed for the medical staff and friends of Baystate Health.

Collaboration
Forward
Baystate Health’s Operating Principles
Trust • Respect • Integrity
Collaboration • Communication
A
moves us
t Baystate Health, we use a series of five operating
principles to guide how we work, the decisions we
make, and the care we provide. When reviewing this
issue of AlphaSights, it occurred to me that the articles
truly reflect one of these key principles: collaboration.
A decade ago, programs described as “multidisciplinary”
were the exception rather than the rule. Patients
had to travel from one hospital department to another
to get opinions from different specialists for a single
condition. Today, our teams of medical experts work
across specialty lines, benefiting not only patients, but
the entire scope of medicine.
Inside this issue, you’ll read how breast surgeons, radiation
oncologists, radiologists, and medical physicists
from the Baystate Regional Cancer Program partner to
offer a new option for breast cancer localization for
lumpectomies. You’ll learn how plastic surgeons, neurosurgeons,
pediatric intensivists, geneticists, and pediatricians
at Baystate Children’s Hospital are revolutionizing
pediatric craniofacial reconstruction. You’ll see pediatric
radiologists, pediatric intensivists, pediatric anesthetists,
and maternal fetal medicine specialists collabo-
rate to provide imaging services to babies and children
of all ages, even in utero. And you will read how radiation
oncologists, thoracic surgeons, oncologists, and
other specialists combine their talents to offer a new
treatment for certain types of cancer.
Collaboration such as this is what drives us forward,
and it extends far beyond clinicians partnering with
other clinicians. As a health system, we collaborate with
our patients, their families, and our community, with
referring providers and community agencies, with local,
regional, and national government leaders, business
leaders and other health care and educational institutions.
The list goes on. And at the core of all of our
collaborative efforts is the patient and our mission “to
improve the health of the people in our communities
every day, with quality and compassion.”
Sincerely,
Mark R. Tolosky, J.D., FACHE
President & Chief Executive Officer
Baystate Health

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Craniofacial
Reconstruction
Restoring Appearance for Children
with Facial and Skull Deformities
By Scott P. Edwards
Cassidy is a vibrant, energetic 18-month-old.
Her life, however, didn’t start out that way.

C
assidy and her fraternal twin brother, Killian, were
born two months premature. While Killian went home
soon after delivery, Cassidy spent 28 days in the
Neonatal Intensive Care Unit (NICU) at Baystate
Children’s Hospital due to low birth weight, failure to
thrive, reflux, and a bowel infection. At two weeks of
age, Cassidy’s doctors diagnosed her with a unilateral
coronal craniosynotosis.
With craniosynotosis, the fibrous sutures in the skull
close prematurely, forming a solid skull and causing
problems with brain and skull growth. Intracranial
pressure increases and the skull and facial bones form
abnormally and asymmetrically. This condition occurs
in about 1 out of 2,200 births.
In Cassidy’s case, a portion of the front of her skull was
misshapen by the craniosynotosis and her eye sockets
were sunken. But using advanced surgical techniques
beginning with Dr. Paul Tessier in France and developed
over the last 50 years, surgeons at Baystate
Medical Center were able to reshape her skull and
advance her orbital bones to give her face and head a
near-normal appearance.
“The waiting and wondering were the worst,” says
Cassidy’s mom, Sarah Leshure, of the weeks and
months following the surgery, “but there have been no
other medical concerns. She’s doing well.”
Comprehensive Program
Craniofacial reconstruction surgery like Cassidy’s is not
new, says Joseph Shin, MD, chief of Plastic Surgery at
Baystate, who performed the procedure on Cassidy,
along with Baystate neurosurgeon Robert Schapiro, MD.
“However, the idea that we could do both the head and
face simultaneously was quite revolutionary,” says Dr.
Shin.
Along with pediatricians, geneticists, pediatric intensivists,
plastic surgeons, and neurosurgeons, Drs. Shin
and Schapiro developed the craniofacial reconstruction
surgery program at Baystate two years ago, in collabora-
tion with Shriners Hospital for Children in Springfield,
which specializes in cleft lip and palate repairs.
“Our goal,” says Dr. Shin, “is to provide holistic care to
our patients and their families.” That care includes a
team of social workers and mental health specialists to
help deal with any psychological issues confronting
patients and families.
The Procedure
The surgical procedure typically involves opening the
entire skull, peeling back the skin to expose the skull
and facial bones, cutting and reshaping the bones, and
inserting resorbable plates and screws to hold the
reshaped bones together.
Drs. Joseph Shin (right) and Robert Schapiro (left) agree that
coordination between the plastic surgeon and neurosurgeon
is essential for successful craniofacial reconstruction.
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Coordination between the plastic surgeon and neurosurgeon
is essential for successful craniofacial reconstruction.
The plastic surgeon’s role is to reshape the
facial deformities, including restoring the function of
“The idea that we could do
both the head and face
simultaneously was
quite revolutionary.”
the patient’s mouth and jaw, as well as improving his or
her appearance. The neurosurgeon focuses on assessing
the patient’s brain function and ensuring that enough of
the skull is preserved to protect the brain as it grows,
while safeguarding the brain, spinal cord, eyes, and
other sensory organs during the procedure. The surgery
is challenging, often taking eight to ten hours to complete,
says Dr. Shin.
Children who have craniofacial reconstruction surgery
typically recover in the Pediatric Intensive Care Unit at
Baystate Children’s Hospital for one to three days of
close monitoring. They then transfer to the general
medical/surgical pediatric unit for a few days before
going home. Some children, depending on the severity
of their deformities or if they are syndromic, require
additional surgery.
The surgery can also benefit patients with relatively rare
developmental anomalies such as Crouzon Syndrome
and Apert Syndrome, which have similar features as
craniosynotosis, including misshapen heads and a
sunken-in appearance to the face, as well as breathing
difficulties and malpositioned teeth caused by deformed
facial bones. Craniofacial reconstruction is also used following
the removal of tumors from the head and face.

Dr. Shin, who as the former director of the Yale
Craniofacial Surgery Center has been performing such
craniofacial surgery for more than a decade, says craniofacial
reconstruction is typically performed on young
children–ideally before they are four months
old–because it is easier to cut and manipulate their
softer bones. By age three, nearly 85 percent of the
brain has developed, says Dr. Schapiro, but the skull is
not well solidified until the teen years and often into
the 20s.
“Once the deformity solidifies,” says Dr. Schapiro, “it’s
difficult to address with surgery.” Cassidy was originally
scheduled for surgery at age five months; however,
because of her difficulty gaining weight, the procedure
was postponed until she was eight months old.
Outcomes
Outcomes at Baystate, say Drs. Shin and Schapiro, are
so far “terrific,” adding that the Baystate surgical team
Mom Sarah Leshure reports that
both Cassidy and Killian are now
happy and energetic toddlers.
Refer a Patient
Baystate Plastic Surgery
2 Medical Center Drive, Suite 309
Springfield, Massachusetts
413-794-5363
provides the best framework for ensuring the safest procedures
with the best outcomes. “The best outcome,”
says Dr. Shin, “is restoration of the shape of the skull
and face as best we can for that particular patient.”
Children do better following facial reconstruction surgery
than adults, who typically take longer to recover.
“Children are so resilient,” says Dr. Shin, “that their
recovery time is relatively fast.”
Cassidy is a case in point, as she and Killian tromp
around a Baystate exam room during an interview
session with her parents and surgeons. She’s also taller
than her brother now, an encouraging sign. “After her
surgery,” says her mother, “she’s happier, more interested
in things, and gaining weight.”
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Stereotactic Body
Radiation Therapy:
A New Option When Few Exist
By Scott P. Edwards
Radiation oncologist Dr. Michael Yunes (left) works
with Dr. Gary Hochheiser (right), chief of thoracic
surgery, to identify non-surgical candidates who
would benefit from SBRT.
A new technology with roots in treating
brain cancer now offers an avenue of hope
for patients with inoperable but early-stage
(stage I and stage II) lung cancer.

F
or many patients with early-stage lung cancer, the
standard treatment–surgical removal of the tumor–is
not an option because coexisting conditions like
emphysema or heart disease make the surgery too risky.
However, the alternatives available to these patients,
including conventional radiation therapy and observation
with no treatment, are not ideal. Conventional
radiation therapy fails to control primary lung tumors
in up to 70 percent of patients, and more than half will
die from disease progression during observation, and
may not be tolerated in patients with poor lung
function.
Stereotactic body radiation therapy, or SBRT, allows
radiation oncologists specialized in the technique to
safely deliver precisely targeted high doses of radiation
through multiple beam angles to a tumor, while at the
same time minimizing radiation damage to adjacent
normal tissue.
“SBRT gives patients an option outside of traditional
approaches, like surgery and conventional radiation
therapy, for certain cancers,” says Michael Yunes, MD,
director of the Stereotactic Radiosurgery Program of
the Baystate Regional Cancer Program. “It’s an option
for many of those who have no other option or who
choose not to have surgery, which is the standard
of care.”
Ensuring Accuracy
SBRT combines the best elements of other forms of
radiation therapy, including the use of multiple radiation
beams to attack a tumor, advanced imaging techniques
to target the tumor, and 4-D (the fourth dimension
is time) imaging for motion control. While the
technique has been used for years to treat intracranial
lesions (Baystate began offering stereotactic radiosurgery
for brain tumors in September 2007), clinicians only
recently began using it to treat cancer outside of the
brain, primarily in the lung, liver, and spine, and for
metastatic disease.
Dr. Yunes says SBRT differs from stereotactic radiosurgery
for brain lesions in several key areas. When
treating a patient with a brain tumor, a rigid frame is
attached to the patient’s head to ensure there is no
movement during treatment. This type of stabilization
system is not suitable for procedures in the chest and
abdomen, because of the patient’s normal respiratory
cycle and all the moving parts in these areas of the
body. Instead, SBRT uses a vacuum technology called
BodyFix to immobilize patients.
“We can offer tighter accuracy
in quality assurance,
planning, and treatment with SBRT.”
BodyFix is like a “big blue beanbag,” says Dr. Yunes.
The patient lies down on a soft cushion and air is
sucked out of it so that it conforms to the patient’s
body. A plastic cover sheet is placed over the patient,
and the air is sucked out of that, as well. This creates a
“comfortable, stable, and precise mold of the patient’s
position for up to six weeks,” according to BodyFix
manufacturer Elekta.
“It’s rather like the patient is vacuum-sealed into it,”
says Dr. Yunes. Patients can’t shift positions once they
are in the BodyFix cushions.”
While the BodyFix system immobilizes the patient, the
overriding technology in SBRT is ExacTrac, a highly
precise radiation delivery system that allows radiation
oncologists to target tumors with millimeter accuracy.
Implantable markers, called fiducials, can be placed in
or adjacent to the tumor to track the tumor during
treatment planning, set-up, and treatment. ExacTrac
uses dual X-ray machines mounted in the floor below
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the linear accelerator that produce X-ray images that
crisscross the body to the digital imaging panels
mounted on the ceiling. This allows more accurate
targeting of the tumor.
“Accuracy is key,” says Dr. Yunes. “We can offer much
tighter accuracy in quality assurance, planning, and
treatment with SBRT.”
This accuracy has great benefit for the patient. Not
only does the tumor receive a very high dose of
radiation, but healthy surrounding tissue is spared.
And, unlike conventional radiation therapy that is
typically delivered in 30 to 40 treatments, SBRT can
be completed in anywhere from one to five sessions.
Dr. Yunes notes the typical treatment for early-stage
lung cancer is three sessions.
Team Approach
SBRT requires the collaboration of several disciplines.
Dr. Yunes works with Gary Hochheiser, MD, chief of
thoracic surgery at Baystate Medical Center, to identify
non-surgical candidates who would benefit from SBRT.
There are several options available for treating lung cancer
patients, including surgery, radiation therapy,
chemotherapy, cryoablation, and radiofrequency ablation.
Because these treatment options are spread across
multiple specialties, “you can’t treat the patient alone,”
says Dr. Hochheiser. “You need a team of different disciplines
to determine the best option for each individual
patient.”
Wilson Mertens, MD, medical director of the Baystate
Regional Cancer Program, says this multidisciplinary
approach also leads to greater efficiency. “Involving the
Left: SBRT uses a vacuum technology called BodyFix
to immobilize patients.
Above: ExacTrac allows radiation oncologists to target
tumors with millimeter accuracy.

key treating specialties in treatment plan development
results in enhanced communication between health
care professionals, and expands the menu of treatment
options we can offer individual patients,” he says. “Our
program’s approach to SBRT ensures that the thoracic
surgeon and radiation oncologist work together on the
treatment plan, leading to appropriate patient selection
and more precise therapy.”
Promising Results
Dr. Yunes says that short-term results at Baystate have
been promising, with excellent tolerance and few side
effects, but it’s too early to tell about long-term outcomes.
As of October, 30 patients had been treated at
Baystate with SBRT, and Dr. Yunes describes the results
as “extremely encouraging.”
In addition, a recent preliminary study in the Journal of
the American Medical Association shows how good outcomes
can be with this treatment.
The study, conducted at the University of Texas
Southwestern Medical Center in Dallas, found that
nearly 56 percent of patients with early-stage lung
cancer who underwent SBRT were still alive three
years after treatment, and that the rate of tumor
control was more than double that found with
conventional radiation therapy.
“The results of this study,” says Dr. Hochheiser, “are
really much better than I would have thought, given
what we know about treating lung cancer.”
Adding Versatility
While 50 percent of the patients treated with SBRT at
Baystate have lung cancer, radiation oncologists are also
using it to treat a variety of cancers, says Dr. Yunes,
including liver, spinal cord tumors, and recurrent head
and neck cancers. Other medical centers have used it to
treat pancreatic, kidney, retroperitoneal, and prostate
tumors.
Dr. Mertens says SBRT adds even more to the comprehensive
cancer care services offered at Baystate and particularly
benefits those who would otherwise have to
travel long distances for SBRT treatment.
“This adds to the versatility of Baystate’s cancer services,”
agrees Dr. Hochheiser. “It’s another tool in our
armamentarium to care for cancer patients, as opposed
to saying ‘we can’t help you’ or ‘we can help you, but
there will be significant side effects.’”
Refer a Patient
Baystate Thoracic Surgery
2 Medical Center Drive, Suite 306
Springfield, Massachusetts
413-794-8050
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Pediatric Radiology:
Imaging for Baystate’s Littlest Patients
By Scott P. Edwards
Pediatric intensivist Dr. Stephen Lieberman (right)
and anesthesiologist Dr. Steven Dunn (left) note
that Baystate is the only hospital in the region
that offers a sedation service for pediatric patients
who require imaging.
The Pediatric Radiology program at Baystate
Children’s Hospital offers specialized imaging
services for neonates, infants, children, adolescents,
and young adults using state-of-the-art
technologies in a safe, child and family friendly
environment.

T
he program offers the full gamut of imaging studies and
image guided pediatric care including standard X-rays,
fluoroscopy, ultrasound, CT, and MRI. The studies are
supervised, performed, and interpreted by radiologists
with subspecialty training.
Pediatric radiologists are experts in selecting the best
imaging techniques to diagnose medical and surgical
problems in infants and children. They are available as
consultants to guide the imaging algorithm and recommend
non-radiation examinations, when appropriate.
The pediatric radiologists ensure that the testing is
performed properly and safely so that an accurate
diagnosis can be made.
Baystate’s Pediatric Radiology program is a subspecialty
within the Department of Radiology. The bright colors and
toys in the pediatric waiting room provide comfort for
children and their families. The exam rooms are staffed by
a dedicated group of radiology technologists who create a
safe, family friendly environment. Nurses and Child Life
specialists are also key members of the team. No other
hospital in the region provides this level and range of
subspecialized care. Three unique initiatives make
Baystate’s Pediatric Radiology program further stand out:
sedation, fetal MRI, and “image gently.”
Sedation
Because most children, especially very young ones, are
unable to hold still for the 15 to 90 minutes it takes to
complete an MRI and other imaging studies, many of
them receive moderate sedation to decrease their movement
so the scan can be completed.
A combined program to support Pediatric Radiology
services was developed with Baystate’s pediatric anesthesiologists
and pediatric intensivists. The pediatric anesthesiologists
and nurse anesthetists from the Department of
Anesthesiology manage infants and children with complex
medical problems and the need for general anesthesia to
complete their MRI studies. Cases requiring moderate
sedation are supported by the pediatric intensivists who
are experienced with the medications used for sedation
as they are widely used in Baystate’s Pediatric Intensive
Care Unit.
“The program started when, rather quickly, there became
an increasing number of children who required some type
of medication for a variety of imaging procedures,” says
Stephen Lieberman, MD, the pediatric intensivist who
started the program. Between 800 to 900 procedures will
be performed this year at Baystate Children’s Hospital.
While many children undergoing imaging studies can be
sedated, others need to be completely unconscious in
order to remain still. “Similar to when anyone has surgery,
we have a system in place to screen pediatric patients and
prepare them for anesthesia,” says Steven Dunn, MD,
interim chair of Baystate’s Department of Anesthesiology.
“Many other places don’t offer this service because it is
labor intensive, and they might not have enough anesthesiologists
who are completely comfortable caring for small
children.”
Pediatric intensivists provide moderate sedation for a variety
of procedures, including interventional radiology
(PICC lines, feeding tubes, arteriograms); CT scan-guided
removal of fluid from the chest, abdomen, and surrounding
the heart; MRIs; ultrasound-guided biopsies of the
kidney and liver; gastrointestinal endoscopies, bronchoscopies,
spinal taps, and bone marrow biopsies; and voiding
cystourethrograms.
Pediatric radiologists (left to right) Drs. Stephen O’Connor,
Tara Catanzano, and Stanley Polansky offer comprehensive
imaging studies and image guided pediatric care including
standard X-rays, fluoroscopy, ultrasound, CT, and MRI.
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In addition to Dr. Lieberman, pediatric intensivists
Christine McKiernan, MD, and Michael Canarie, MD,
are part of the program, as well as Rebecca Blanchard,
RN, who assists with the large volume of MRIs that
require sedation.
“We are the only hospital in the area to offer this service
because Baystate Children’s Hospital is the only institution
in Western Massachusetts with the expertise to do
it safely, especially the nursing personnel who place the
IVs and monitor the children,” says Dr. Lieberman.
Fetal MRI
Baystate Medical Center is also the only institution in
Western Massachusetts that offers fetal MRI. Stephen
O’Connor, MD, pediatric radiologist, has primary
responsibility for this service. “Fetal MRI is a powerful
tool that can expand and confirm information obtained
from the high quality ultrasounds performed by our
colleagues in Maternal Fetal Medicine. It allows us to
further investigate potentially serious fetal anomalies in
the brain, spine, thorax, and abdomen without the use
of sedation or radiation.”
Unique to fetal MRIs, Dr. O’Connor says he actually sits
at the console with the MRI technologist so that the
images can be obtained quickly to account for fetal
motion. “This makes it especially challenging,” he says.
“When we see certain anomalies on ultrasound in either
the fetus or the mother,” says Baystate Maternal/Fetal
Medicine specialist Fadi Bsat, MD, “MRI can help. It
can also be helpful in conditions that could change the
management of the pregnancy or in preparation for
possible complications at delivery.”
Dr. Bsat says fetal MRIs are most often used at Baystate
for fetal central nervous system abnormalities or fetal
chest or neck masses. For example, ultrasound may not
be able to determine if a baby with a chest mass will be
able to breathe after delivery, but MRI can tell physicians
if the baby’s lungs may be compromised and intubation
or other interventions are required at delivery.
Dr. O’Connor adds, “The push to add fetal MRI at
Baystate came from a group of specialists including
pediatric surgeons, geneticists, neonatologists, and
maternal fetal specialists, who approached us because at
the time, the closest place offering fetal MRI was in
Boston. Traveling that far was often a hardship for
patients, so offering this subspecialty locally is a
tremendous benefit for patients, making it much more
likely they’ll stay with Baystate for the remainder of
their pre- and post-natal care. It also offers positive
implications for our graduate medical education programs
in obstetrics/gynecology, surgery, pediatrics, anesthesiology,
and radiology.”
Maternal Fetal Medicine specialist
Dr. Fadi Bsat says fetal MRIs are
most often used at Baystate for
fetal central nervous system
abnormalities or fetal chest or
neck masses.

MRI is also used for the health of the mother, especially
in trauma cases in which the mother’s abdomen or
pelvis is involved and for whom X-ray or CT scan may
be associated with some fetal risks. It can also help
detect problems such as placenta accreta, a severe
obstetric complication involving strong attachment of
the placenta to the uterine wall, which can cause severe
bleeding with detachment.
Image Gently
Radiation exposure, including medical radiation, is a
concern for both adults and children. This is particularly
important in children since their tissues are more
radiosensitive. Children have a longer lifetime in which
to manifest radiation-induced injury. Each examination
should be considered cumulative and therefore more
likely to result in adverse health effects.
Baystate’s Pediatric Radiology program has been active
for years in efforts to reduce medical radiation in children.
This goal is fostered through a long-term involvement
in the Society for Pediatric Radiology and, since
2006, in the Alliance for Radiation Safety in Pediatric
Imaging. Baystate’s program has participated in the
national “image gently” campaign since its inception.
The motivating principle is to change medical and radiology
practice by increasing awareness of the opportunities
to lower radiation doses when imaging children.
“At Baystate, we respect the fact that children are more
susceptible to radiation problems than adults,” says
Stanley Polansky, MD, chief of Pediatric Radiology, “so
we use the lowest possible levels of radiation. We took
the pledge to ‘image gently,’ and we adhere to the principles
expounded by the Alliance.”
With the help of medical physicist M. Terry LaFrance,
Baystate’s pediatric radiologists follow the ALARA (As
Low As Reasonably Achievable) principle of radiation
safety, scaling back radiation doses for children.
“This is a dynamic process with constant monitoring of
techniques to further cut back radiation exposure, particularly
in CT,” says Dr. Polansky. “In general, properly
performed CT examinations of children should expose
a child to much lower exposures than those for the
same procedure on an adult. The potential benefit from
an indicated CT examination is clinically recognized
and documented and is far greater than the potential
cancer risk.”
In addition, Dr. Polansky and his colleagues Drs.
Stephen O’Connor and Tara Catanzano, serve as
resources for referring physicians and patients’ families.
They offer advice about what imaging procedures are
appropriate and what imaging alternatives are available
that do not use radiation.
“The role of the pediatric radiologist is multifold,” says
Dr. Polansky. “It is to understand radiation doses;
review requests for higher dose studies; discuss cases
with clinicians; use appropriate technical factors; help
spread current knowledge about radiation doses; train
medical students, residents, and radiology technologists;
educate health care providers; and participate in
Professional Quality Improvement programs.”
“Our pediatric radiologists do not fit the profile of a
typical ‘adult’ radiologist,” says Laurie Gianturco, MD,
chair of Radiology at Baystate Medical Center. “They
spend a lot of time working closely with patients and
their families, and the pediatricians and surgeons at
Baystate and in the community.”
Dr. Polansky concludes, “When a child is referred to
us, their family can feel secure that they are going to
a center that provides special attention to children,
offers a safe and friendly environment, accomplishes
imaging exams with high degrees of success, and
adheres to principles for using the least amount
of radiation possible.”
Refer a Patient
Baystate Children’s Hospital
759 Chestnut Street
Springfield, Massachusetts
413-794-2222
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14
Radioactive Seed Localization:
A New Option for Women Undergoing Lumpectomies
By Suzanne Spiry
Dr. Holly Mason, director, Breast Surgical Services,
meets with a patient after her lumpectomy using
radioactive seed implantation.
Surgical specialists from Baystate’s
Comprehensive Breast Center now offer
an alternative to wire localization to more
precisely locate and remove affected
breast tissue during a lumpectomy.

“A
s the technology behind screening mammograms
has become more refined,” says Grace Makari-Judson,
MD, medical director, Comprehensive Breast Center,
“we are able to detect a greater number of breast
abnormalities and cancers before they can be felt with
a physical exam. While this allows us to catch problems
earlier than ever, it also makes the affected tissue
more challenging to precisely locate and remove.”
For women with breast cancer who will undergo a
lumpectomy, the wire-localization procedure (WLP)
has long been the standard. With this protocol, the
radiologist places a guide-wire into the area of concern
in the breast using mammography prior to the
surgery. During the surgery, the surgeon removes the
tissue surrounding the guide-wire and sends it to the
laboratory for biopsy.
“While WLP is very useful, it also presents several
challenges,” says Holly Mason, MD, director, Breast
Surgical Services. Since the guide-wire cannot be
placed into the breast until the day of surgery, scheduling
the surgery is more complicated. The placement
of the wire is very uncomfortable for the patient. The
wire may shift or be dislodged, decreasing the accuracy
of the procedure. The wire is very thin and can be
difficult to feel within the breast tissue, and the location
where the wire exits the skin does not always
reflect the location of the tumor, making incision
planning difficult. Finally, the wire and the mammograms
showing the wire placement provide only a limited
view of the location of the tumor, which can
make removal of the tissue less accurate, potentially
requiring a re-excision.
Radioactive seed localization (RSL) offers a new alternative.
With this procedure, a radiologist places a very
low-energy radioactive seed into the abnormal tissue
or tumor, guided by mammography. During the surgery,
the surgeon uses a handheld Geiger counter to
more precisely identify the location of the tumor. The
Geiger counter also allows the surgeon to obtain a
three dimensional view of the tumor’s location.
RSL offers multiple benefits over WLP. The radiologist
can implant the seed up to a week before the surgery,
thereby making the scheduling process easier and
reducing the wait time for patients. The seed placement
is also better tolerated by patients than the wire.
Dr. Mason is currently the
only surgeon in the region
trained to perform
the radioactive seed
localization procedure.
More importantly, notes Dr. Mason, who is currently
the only surgeon in the region trained to perform the
RSL procedure, RSL provides increased accuracy over
WLP. With RSL, the surgeon knows the precise location
of the tumor and can more accurately plan the
surgical incision. This also reduces the length of the
surgery. In addition, studies show that RSL reduces
the need to have a second surgery due to incomplete
removal of the abnormal tissue.
Seed Implantation
Patients have an appointment at Baystate’s Chestnut
Surgery Center up to a week prior to their surgery for
the implantation of the seed. A specially-trained radiologist
performs the seed implantation, assisted by a
mammography technologist.
15

16
The seed placement procedure is very similar to a needle
biopsy procedure. The radiologist injects a local
anesthetic to numb the area before starting the procedure.
Mammography is used to guide placement of
the seed. The seed (Iodine 125 or I-125) is of very
low energy, and its placement is not considered to be
dangerous to the patient.
Studies show that
RSL reduces the need
to have a second surgery
due to incomplete removal of
the abnormal tissue.
On the day of the lumpectomy, the patient arrives
about two hours before the surgery, and receives an IV
with light sedation, and a local anesthetic to numb the
surgical area. After the surgeon removes the abnormal
tissue or tumor along with the radioactive seed, the
incision is closed and bandaged. Once the seed is
removed with the breast tissue, all of the radioactivity
is gone. The patient is able to leave the hospital later
that same day.
Most patients are potential candidates for RSL, with
the exception of women who are pregnant, women
who have implants, or women with lesions close to
the chest wall or skin. While there is likely little risk
to the fetus because of the low energy radiation of the
seed, it is best to avoid any radiation exposure, so
pregnant women are scheduled for the wire-localization
procedure. Women who are breastfeeding are
asked not to nurse while the seed is in place.
“We are very pleased with the results we have seen so
far,” says Dr. Mason. “The seed allows me to be much
more accurate during the surgery while reducing the
amount of time it takes, and the process is smoother
for the patient as well.”
Refer a Patient
Baystate Regional Cancer Program
Comprehensive Breast Center
3400 Main Street
Springfield, Massachusetts
413-794-9338

Welcome
New Physicians
Baystate Medical Center and
Baystate Medical Practices
proudly welcomes the following
physicians to its medical staff.
Baystate Heart and
Vascular Program
Laura Feldman, MD
Baystate Vascular Services
3500 Main Street, Springfield
413-794-3282
Neurology
Anant Shenoy, MD
Baystate Neurology
3300 Main Street, Springfield
413-794-7033
Cardiology
Gregory Valania, MD
Baystate Cardiology
3300 Main Street, Springfield
413-794-7246
Hospital Medicine
Aroosa Alam, MD
759 Chestnut Street, Springfield
413-794-4320
Gastroenterology
Angelica Chiomo Belo,
MBBS, MD
Baystate Gastroenterology
3300 Main Street, Springfield
413-794-7364
Hospital Medicine
17
Sabarish Ram Ayyappan, MD
759 Chestnut Street, Springfield
413-794-4320

18
Welcome New Physicians
Hospital Medicine
Muzzaffar Hussain, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Bharanidhar Chandrasekaran, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Halil Mutlu, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Kyamalya Ismailova, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Nishant Dhungel, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Abhijit Naik, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Puneet Menaria, MD
759 Chestnut Street, Springfield
413-794-4320

Hospital Medicine
Adrianne Seiler, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Gaurav Narula, MD
759 Chestnut Street, Springfield
413-794-4320
Emergency Medicine
Scott Millay, MD
759 Chestnut Street, Springfield
413-794-3343
Hospital Medicine
Kirti Talole, MD
759 Chestnut Street, Springfield
413-794-4320
Hospital Medicine
Phyllis Owusu-Griffin, MD
759 Chestnut Street, Springfield
413-794-4320
Emergency Medicine
Elizabeth Schoenfeld, MD
759 Chestnut Street, Springfield
413-794-3343
Emergency Medicine
Jennifer Cyrkler, MD
759 Chestnut Street, Springfield
413-794-3343
19

20
Surgery
Surgery
Thomas Kaye, MD
Baystate Neurosurgery
2 Medical Center Drive, Springfield
413-794-4440
Salman Ahmad
Baystate Trauma Services
2 Medical Center Drive, Springfield
413-794-8020
Surgery
Surgery
Ben Schalet, MD
Baystate Plastic Surgery
2 Medical Center Drive, Springfield
413-794-5363
Surgery
Jacqueline Lee, MD
Baystate Thoracic Surgery
2 Medical Center Drive, Springfield
413-794-8050
Andrew Doben, MD
Baystate Trauma Services
2 Medical Center Drive, Springfield
413-794-8020
Surgery
Surgery
Clemons Schirmer, MD
Baystate Neurosurgery
2 Medical Center Drive, Springfield
413-794-4440
Pranay Parikh, MD
Baystate Plastic Surgery
2 Medical Center Drive, Springfield
413-794-5363

Primary Care
Sharon Wretzel, MD
Baystate Mason Square
Neighborhood Health Center
11 Wilbraham Road, Springfield
413-794-3710
Primary Care
Gina Luciano, MD
Baystate High Street Health Center
140 High Street, Springfield
413-794-2511
Psychiatry
Lawrence Peters, MD
Baystate Behavioral Health
3300 Main Street, Springfield
413-794-7035
Psychiatry
Stuart Anfang, MD
Baystate Behavioral Health
3300 Main Street, Springfield
413-794-7035
Welcome New Physicians
Primary Care
Ahmad Waseef, MD
BMP East Longmeadow Adult Medicine
294 N. Main Street, East Longmeadow
413-525-4555
Psychiatry
Cassandra Danielle
Hobgood, MD
Baystate Behavioral Health
3300 Main Street, Springfield
413-794-7035
Physical Medicine & Rehabilitation
Jonathan Richmond, MD
Baystate Physical Medicine and Rehabilitation
294 North Main Street, East Longmeadow
413-794-1150
21

22
Honors &
Announcements
Sandra Bellantonio, MD, Baystate
Geriatric Medicine, was promoted to
chief of Geriatrics and Post Acute
Medicine at Baystate Medical Center.
Evan Benjamin, MD, vice
president/chief quality officer for
Baystate Health, was honored as a
Quality Leader by the Massachusetts
Medical Law Report for “RX for
Excellence,” honoring the best
practices in medicine.
Christine Bryson, DO, a hospitalist at
Baystate Medical Center, was inducted
as a “Fellow in Hospital Medicine” by
the Society of Hospital Medicine. This
honor is bestowed on those who have
demonstrated their commitment to
hospital medicine and quality improvement
practices in the hospital setting.
Mark Hirko, MD, chief of Vascular
Surgery at Baystate, was appointed to
the editorial board of the Journal of
Vascular Surgery as a section topic
reviewer. He is also on the editorial
board of Current Surgery.
Paul Jodka, MD, Critical Care
Medicine Division, begins a two-year
term on the Palliative and End-of-Life
Care Network Steering Committee in
Vancouver, BC, Canada. He was also
selected for a one-year appointment to
the ACCP’s Ethics Committee.
Sandra Bellantonio, MD
Jeffrey Kaufman, MD, Baystate
Vascular Services, was reappointed to
the editorial board of the Journal of
Vascular Surgery. He has served on the
board for over a decade.
James Nichols, PhD, Baystate
Pathology Diagnostic Medicine Services,
received the “Professor Alvin Dubin
Award for Outstanding Contributions
to the Profession and the Academy.”
The award recognizes a member of the
National Academy of Clinical Biochemistry
(NACB) who has made noteworthy
advances enhancing the mission and
stature of NACB.
Evan Benjamin, MD
Mark Hirko, MD Paul Jodka, MD
Baystate CLINICAL WEB
Christine Bryson, DO
Christopher Otis, MD, director of
Surgical Pathology at Baystate, was
appointed to the College of American
Pathologists Cancer Committee. He
also serves as the Cancer Committee’s
Gynecologic Malignancies subcommittee
chair.
Niels Rathlev, MD, chair of the
Department of Emergency Medicine,
was elected to the Board of Directors
and Executive Committee of the
Massachusetts College of Emergency
Physicians.
Baystate Health is pleased to announce a new way to access your patients’ health information related
to all encounters that occur within any of the Baystate Health facilities.
Baystate Clinical Web is a web-based application that provides real-time simplified viewing of patient
encounter information, clinical data, laboratory, radiology and
pathology results, documents, and reports. Circumventing the need
to login to the Baystate network, you can securely log into Baystate
Clinical Web from any remote site with the single entry of username
and password.
The data are displayed in an intuitive user interface that facilitates
“read-only” review of vital patient information. The data can be
organized and sorted by individual physician, practice group, or
other custom lists. In addition, individual patient names can be
searched and, with the explicit declaration of a clinical
relationship, access can be provided for acute care
purposes, e.g. emergency or inpatient services.
To gain access to Baystate Clinical Web, please call the
Baystate Health Help Desk at 413-794-3000.

Jeffrey Kaufman, MD
John Santoro, MD
James Nichols, PhD
John Santoro, MD, vice chair of the
Department of Emergency Medicine,
was reelected to the Pioneer Valley Red
Cross Board of Directors.
James Stewart, MD, chief of
Hematology/Oncology, received the
“Appreciation Award for Role in
Developing Medical Oncology In-training
Exam” from the American Society
of Clinical Oncology (ASCO) and
Medical Oncology Program Directors.
Dr. Stewart worked with ASCO to generate
enthusiasm for a national exam
for medical oncology fellows. He
chaired the test writing committee for
its first two years and remained on the
committee for two more years.
Winthrop Whitcomb, MD, a hospitalist
and medical director of Healthcare
Quality at Baystate Medical Center, was
inducted by the Society of Hospital
Medicine as one of three founding and
inaugural “Masters in Hospital
Medicine” at its annual meeting. They
were honored for their visionary contributions
for improving hospital medicine
and serving as pioneering leaders in this
emerging field. The Masters in Hospital
Medicine represents the highest honor
in hospital medicine. A practicing hospitalist
for 16 years, Dr. Whitcomb also
serves as the physician advisor on
Quality Initiatives for the Society of
Hospital Medicine.
James Stewart, MD
Christopher Otis, MD
Academic
Honors & Updates
Baystate Medical Center is the region’s
only academic teaching hospital and
serves as the Western Campus of Tufts
University School of Medicine (TUSM).
Awards
• Carlos Acevedo, MD, a hospitalist at
Baystate Medical Center, was
awarded “Teacher of the Year” by
Tufts University School of Medicine
third year medical students, one of
the highest honors in education at
any teaching hospital.
• Julio Martinez-Silvestrini, MD,
Baystate Physical Medicine &
Rehabilitation, was selected “Teacher
of the Year” by Tufts University
School of Medicine physical medicine
and rehabilitation (PMR) residents.
Over the last several years, he has
conducted conferences for PMR
residents on selected topics in sports
medicine and musculoskeletal
medicine.
Niels Rathlev, MD
Winthrop Whitcomb, MD
Accreditations
Baystate’s Critical Care Medicine
fellowship program was awarded
continued accreditation for the maximum
of five years by the Accreditation
Council for Graduate Medical Education
(ACGME). Mark Tidswell, MD, serves as
the program director.
Baystate’s Cardiovascular Disease
fellowship program was awarded
continued accreditation for the maximum
of five years by the ACGME.
Mara Slawsky, MD, serves as the program
director.
23
Baystate Medical Center is the
Western Campus of
Tufts University School of Medicine.

24
M A R C H
Saturday, March 12
Chestnut Conference Center, Springfield
Update in Endoscopy
Audience: GI nurses, GI technologists, mid-level
providers, and clinical specialists
Saturday, March 19
Chestnut Conference Center, Springfield
Annual Anesthesiology Symposium
Audience: anesthesiologists, nurse anesthetists, and post
anesthesia care unit nurses
Thursday, March 24
The Log Cabin, Holyoke
Trends in Pulmonary Care
Audience: nurse practitioners, clinical nurse specialists,
nurses, respiratory therapists, and case managers
Friday, March 25
The Log Cabin, Holyoke
Memory Disorders
Audience: physicians, nurse practitioners, nurses, clinical
social workers, psychologists, and mental health
counselors
Wednesday, March 30
Baystate Health Education Center, Holyoke
Controversies in Women’s Health: Menopause 2011
Audience: Ob/Gyn physicians, internists, nurse-midwives,
nurse practitioners, and nurses
Wednesday, March 30
Baystate Health Education Center, Holyoke
Update: An Evidence Based Approach to Herbal
Medicine with Tierona Low Dog, MD
Audience: primary care providers including physicians,
nurse practitioners, physician assistants, and nurses
Baystate Health
Continuing Education Calendar
Winter 2011
For course information and registration or to access your personal
BH Continuing Education transcript, go to baystatehealth.org/learn.
ACLS, ENPC, PALS, and TNCC
Basic Life Support (BLS) is a prerequisite. All classes
are held at the Baystate Health Education Center
in Holyoke.
January 13-14
(PALS) Pediatric Advanced Life Support
January 27-28; March 17-18
(ACLS) Advanced Cardiac Life Support
February 8-9
(TNCC) Trauma Nursing Core Course
February 24
(ACLS) Advanced Cardiac Life Support
Recertification
March 8-9
(ENPC) Emergency Nursing Pediatric Core
March 16, 2011
(PALS RECERT) Pediatric Advanced Life Support
Recertification
Winter 2011
Online Courses
If scheduling problems prevent you from attending CE events, consider
taking online courses for credit at baystatehealth.org/learn. Courses are
presented by Baystate Health faculty and visiting professors, and include
interactive post-tests, online evaluations, and the ability to print your
attendance verification immediately.

Medical & Nursing Positions Available
at Baystate Health
Baystate Medical Center,
Springfield
• Clinical Pharmacists
• Histotechnologists
• Medical Assistants (AAMA
Certified)
• Medical Technologists
• Physical Therapists
• Registered Nurses
Cardiac Telemetry
Cardiovascular Intensive Care
Emergency Department
Home Care: Med/Surg
Medical Practice/Community Health
Oncology
OR and Heart & Vascular OR
Post Anesthesia Care Unit
• Respiratory Therapists
• Social Worker (LCSW, LICSW)
• Surgical Technologist
• Vascular Sonographers
Baystate Franklin Medical
Center, Greenfield
• Physical Therapist for Spine
and Sports
• Per Diem RN Case Manager
Baystate Mary Lane
Hospital, Ware
• Surgical Technologists
Baystate Visiting Nurse
Association & Hospice
• Physical Therapists
• Registered Nurses
Physician Career
Opportunities
Call 413-794-2571,
fax 413-794-5059, or email:
John.Larson@baystatehealth.org
Physician Leadership Opportunities
Critical Care & Pulmonology, Chief
Developmental & Behavioral Pediatrics,
Chief
Pediatric Infectious Diseases, Chief
Physician Faculty &
Staff Opportunities
Child & Adolescent Psychiatry
Critical Care Medicine
Critical Care Pulmonology
Emergency Medicine
Gastroenterology
General Surgery
Geriatric Medicine
Hospitalist Medicine
Internal Medicine
Medicine/Pediatrics
Neurology/Epilepsy
Occupational Health
Outpatient Primary Care
Pathology
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatrics/General
Pediatric Genetics
Pediatric Neurology
Post Acute Medicine
Psychiatry
Urology
Vascular Surgery
Advanced Practitioner
Opportunities
Cardiac Stress Lab
Cardiovascular Surgery
Certified Nurse-Midwives
Community Health Medicine
Community Hospital Medicine
Cardiac Device Program
Electrophysiology Lab
Emergency Medicine
Endocrinology, Diabetes & Metabolism
Gastroenterology
Hematology/Oncology
Infectious Disease Management
Internal Medicine Primary Care
Neonatal ICU / Nurse Practitioner
Neurosurgery Practice
Occupational Health
Oncology
Orthopedics Practice
Neurology
Thoracic Surgery Practice
Trauma Surgery
Urology Practice
To Learn More
about career opportunities within Baystate Health or to apply for
a specific position, apply online at baystatehealth.org/jobs,
or call 1-800-767-6612. EOE/AA