GLOSSARY BEYOND IMA
Angiography: the endoscopy and fluoroscopy. imaging depicting the
radiographic visualization spatial distribution of
of the blood vessels. Endorectal coil MRI: uses metabolic or biochemical
magnetic resonance imaging activity in the body.
Angioplasty: the technique in conjunction with a coil Just as computers have changed our lives,
of mechanically widening a placed into the rectum to PET-CT: combines positron so have they changed medicine.
narrowed or obstructed obtain high-quality images emission tomography with In the beginning there was the x-ray, a one-
blood vessel. of the surrounding area. x-ray computed tomography dimensional picture used to diagnose
so that images acquired physical conditions. For 70 years, x-rays
Biplane neuroangiography: Fluoroscopy: the use of from both devices can be
a fully digital system that “live” x-rays to obtain taken sequentially and
were the only imaging device available.
enables physicians to real-time moving images combined into a single
capture and view detailed of the internal structures image. The PET-CT has Today, there are dozens of imaging devices
3-D images of a patient’s of a patient. revolutionized many fields performing dozens of functions. And today,
vascular structure, that can of medical diagnosis by these instruments do more than provide
also create “CT-like” images. Magnetic resonance adding precision of information. They have evolved into therapeutic
imaging (MRI): a anatomic localization to tools, providing new hope for people with a
CT scanner: a medical sophisticated scanning functional imaging, which variety of conditions – especially those whose
instrument consisting of technique that noninvasively was previously lacking from condition is inoperable or who cannot tolerate
integrated x-ray and produces computerized pure PET imaging. an operation. Each of these new machines gives
computing equipment that images of internal body rise to an ever-expanding range of treatment
provides a cross-sectional tissues, based on nuclear Ultrasound: exposes part of techniques, opening up a whole new world of
x-ray with a detailed image magnetic resonance of the body to high-frequency possibilities for patients.
of areas including soft atoms within the body sound waves to produce
tissue, organs and major induced by the application real-time pictures of the Today’s computer-guided technology helps
blood vessels. of radio waves. inside of the body. surgeons enter tiny veins and vessels to remove
blockages, conduct biopsies, deliver treatments
Cyclotron: produces the Myelography: a type of X-ray: the oldest and most to certain cancerous growths and more – giving
radiopharmaceuticals used radiographic examination frequently used form of people a better chance of life, with less invasive
for PET imaging. that uses a contrast medium medical imaging, it involves procedures, less pain and quicker recovery.
to detect pathologies of the exposing a part of the body
EBUS: endobronchial spinal cord. to a small dose of ionizing “Computer technology has changed
ultrasound. radiation to produce everything,” said Prof. Eugene Libson, Head of
PET: a medical instrument pictures of the inside of the Dept. of Radiology and Medical Imaging.
ERCP: a combination of that displays functional the body. “What we did 20 years ago seems obsolete. It’s
exciting. The future will be even more amazing
and more exciting.”
MAGINATION: THE IMPACT OF IMAGING
Often Hadassah was the first medical center in detect a tumor, to see if cancer has extended beyond
THE FIRST X-RAY Israel to acquire these advanced machines; often the prostate gland and consider treatment options.
Hadassah remains the only medical center in The endorectal-coil MRI is critical in considering
Over 100 years ago, in 1895, German physicist Israel that has them and uses them in such a treatment options.”
Wilhelm Roentgen discovered the medical use sophisticated manner.
for his scientific investigations when he saw a “Hadassah is the first in Israel to use endo-
picture of his wife's hand on a photographic “It really doesn’t matter what the machine is,” said bronchial ultrasound (EBUS) to biopsy lymph
plate formed due to x-rays. Dr. Tamar Sela of HMO’s Dept. of Diagnostic nodes and tumors in the chest,” said Dr. Neville
Radiology, “as long as it provides the information we Berkman, Head of the Department of Invasive
need for better diagnosis and better treatment. Pulmonology in the Institute for Pulmonary Medicine.
Adding new modalities means we are detecting more
cancers at earlier stages – the more information, the “Standard fiber-optic flexible bronchoscopy allows
more informed the decision. direct visualization of the major airways. The EBUS
is a new type of bronchoscope with an ultrasound
“Hadassah was the first to use MR-guided probe at its tip that provides accurate images of
biopsies for breast tumors,” Dr. Sela said. structures in the chest that are outside but in close
“Mammograms are not conclusive for some women proximity to the airways, such as lymph nodes and
with dense breasts. Ultrasound provides additional blood vessels. "Using EBUS, for the first time we are
information, but for women at high risk – BRCA gene able to accurately biopsy these structures under
carriers – an MRI reveals even more. “We used to tell direct vision. Previously we could only reach these
women to wait and see what develops. Now, with sites by performing an invasive surgical procedure.
MR-guided biopsies, we have the results in a week.
The ability to diagnose makes a difference in the “The presence of cancer in the lymph nodes of the
treatment plan – and in the patient’s emotional chest is the first sign that the disease has spread and
wellbeing,” Dr. Sela said. assessment of the lymph node involvement is critical
in deciding whether a patient is eligible for surgery.
“Hadassah is also the only place in Israel “Until we had this new technology,” Dr. Berkman
performing endorectal-coil MRIs for prostate said, “we used the CT and PET for diagnosis,
cancer. We are the referral center for the entire knowing there was about a 20 percent chance of
country. Prostate cancer is detected by a blood error. The EBUS is 92-96 percent sensitive to
test; since we can’t yet use the needle biopsy in identifying cancer in lymph nodes. The addition
these cases, we use an endorectal-coil MRI to of this modality to standard imaging techniques
BEYOND IMAGINATION: THE IMP
will greatly improve our ability to better stage to treat small tumors of the bone that previously of the bile ducts in newborns.
and treat lung cancer patients.“ had to be treated surgically. Most of these tumors
occur in children between the ages of one and “ERCP enables the physician to see inside the
“Hadassah was the first in Israel to perform 13. In the past seven years, he has performed stomach where we check babies suspected of
thermal ablation therapy and is the leading more than 100 of these procedures, with a having biliary atresia and jaundice,” said Prof.
center for tumor ablation therapies in Israel,” success rate of 95 percent. Eran Goldin, Head of Gastroenterology Services.
said Dr. Liat Appelbaum of the Radiology
Institute. “Patients are referred from all over the “Modern imaging technology,” he said, Biliary atresia is a rare, life-threatening disease
country for state-of-the art ablation treatments “enabled better views of the tumor’s form and that damages the liver in newborns, and
of liver, lung and kidney tumors, with good long structure, better guidance by real-time viewing jaundice, while common among infants, can be
term results in defeating cancer – very similar of the anatomy and better control of the high- cause for concern – and even death – in
to those of the leading centers in the U.S. tech ‘knives,’ lasers, gamma rays and radio newborns and of lifelong neurologic
frequency. Using a CT machine, we are able to consequences in those who survive.
Left kidney tumor be very, very precise – to the smallest millimeter.
The CT gives the surgeon a way to see into “The diagnosis must be made within four to five
the bone.” weeks of birth,” Prof. Goldin said, “so we can
operate and correct the condition. Hadassah
Recently Dr. Peyzer has successfully been using performs 60 to 80 exams a year using ERCP. If
this technique on several children with larger the babies are normal, we have averted an
tumors with considerable success. operation. Before ERCP, we would have had to
Left: Renal cell carcinoma before treatment. operate to find out if the condition existed.”
Center: Radio frequency electrode inside the Hadassah is the only place in Israel and one
tumor during treatment. Right: Ablated non- of about 10 places around the world using “Hadassah made a major contribution to
viable tumor after treatment. ERCP – a combination of endoscopy and Israeli medicine when it installed the
fluoroscopy – to diagnose and treat conditions
“Nearly all the patients – 98 percent of them – country’s first PET machine and cyclotron,”
go home the day after ablation with minimal said Prof. Roland Chisin, Head of the Department
pain or discomfort, making this procedure an of Medical Biophysics and Nuclear Medicine.
exciting and elegant treatment, competitive “PET (positron emission tomography), a
with surgical excision in selected cases,” sophisticated nuclear medicine technology,
Dr. Appelbaum said. opened up a new frontier by providing
functional images, revolutionizing patient
Dr. Amos Peyzer of the Department of treatment decision-making and post-treatment
Orthopedic Surgery is using the same procedure followup, in particular in cancer diseases."
MPACT OF IMAGING A 52-year-old Israeli journalist was critically
injured in the recent armed conflict in the former
Soviet republic of Georgia. After he was transferred
by air ambulance to Hadassah’s Intensive Care Unit,
a whole body CT scan revealed a previously
undiagnosed life-threatening injury to the main
artery supplying the left leg. Due to his complex
and unstable medical condition, Prof. Allan Bloom
“Hadassah still has the only hospital-based
treated him in the interventional radiology unit
cyclotron in Israel and is about to acquire using state-of-the-art endovascular techniques.
another one,” said his colleague Prof. Eyal Mishani,
Head of the Cyclotron Radiochemistry Facility in Under local anesthesia, a diagnostic angiogram
the Department of Medical Biophysics and revealed a major tear of the superficial femoral
Nuclear Medicine. artery (figure 1 - arrow). A covered stent was inserted
into the injured artery to reconstruct the vessel
Prof. Mishani, a research scientist, is constantly (figure 2 - arrow). This minimally invasive procedure
searching for ways to create new PET imaging agents saved the patient's leg and life, while completely
that are responsive to different types of cancer, obviating the need for major surgery with all its
developing different tracers to measure different inherent risks and potential complications.
conditions. For example, neuro-endocrine tumors
cannot be imaged with the FDG-PET agent used to
diagnose many cancers, so a new tracer is being
used at Hadassah that can identify that type of cancer.
Choline and acetate novel compounds labeled by And for prostate and bladder cancer, determining
the C-11 isotope. Presented at the American Society the exact location of the cancerous cells helps
of Nuclear Medicine, Toronto 2009. surgeons determine their procedure. Prof. Chisin
and Prof. Mishani collaborated with Dr. Ofer Gofrit
As a leader in PET brain imaging in Israel, Hadassah of the Department of Urology and developed a
is now testing a new drug for people suffering from tracer labeled with the C-11 isotope that can clearly
Parkinsons disease. visualize prostate and bladder cancer. When there is
a treatment dilemma –– C11 Choline-PET makes
“Hadassah is also a pioneer in hybrid imaging,”
he continued. “The acquisition of the PET-CT hybrid
had a dramatic impact on cancer treatment and follow- Hadassah was the first in the world to publish
up. The CT provides an anatomical image and the its experience in treating advanced cancers of
PET, the metabolic biochemical information. When the bladder.
the images are superimposed, they produce one
picture with anatomical and functional information. Today, computer guidance is commonplace in almost
Determining the exact location of the cancerous cells all fields of medicine. Better imaging technology and FIGURE 1 FIGURE 2
helps surgeons determine their procedure.” better devices are responsible for the sweeping
BEYOND IMAGINATION: THE IMP
change from open surgery to minimally intervention is very effective, non-traumatic and
invasive procedures, often performed using saves lives.”
local rather than general anesthesia. Patients
benefit because the surgery takes less time – as Prof. Bloom handles problems that occur from
does their recovery. the neck down, he said with a grin, and Prof.
Jose Cohen, those from the neck up. An
“What was once peripheral has now become endovascular neurosurgeon and interventional
our key specialty. Only 15 years ago, angiography neuroradiologist in the Dept. of Neurosurgery,
was 50 percent diagnostic and 50 percent Prof. Cohen credits the state-of-the-art Biplane
interventional,” said Prof. Allan Bloom, Chief of neuroangiography machine with enabling
Vascular and Interventional Radiology in the physicians to accurately diagnose vascular
Dept. of Radiology and Medical Imaging. “Today disorders of the neck and brain such as cerebral
95 percent of our work is intervention.” aneurysm and arterial malfunction.
One example, Prof. Bloom noted, is the “But more than simply providing superb
treatment of aortic aneurysms. These diagnoses, the machine is a treatment tool,”
threatening bulges and weaknesses in the major he said. “With it, we can treat conditions that
blood vessel that feeds blood to the body can were previously untreatable or required complex
sometimes be life-threatening. They used to be neurosurgery, such as ischemic strokes that
repaired by opening the abdomen or chest and are usually caused by a blockage in an artery
surgically correcting the condition. to the brain.
Now, using computer-guided minimally invasive “There is no surgical way to reopen arteries, but
endovascular techniques, doctors attach a with this tool, we can reopen arteries and
synthetic graft to the end of a thin tube or remove the clot,” Prof. Cohen said. “In the angio
catheter, insert it through an artery in the leg room where we work on minuscule blood
and thread it up into the aorta, where they repair vessels from a distance of a little more than a
the damage using a variety of devices. yard, I see things I never imagined I could see.
That lets us literally save lives that couldn’t be
“Cutting-edge imaging devices allow the doctors saved before.”
to target the treatment,” he said, “especially
when dealing with severe trauma, such as “Since the advent of the CT in 1973 and the MRI
profuse bleeding from major pelvic fractures in 1982, a continuous technological evolution
or postpartum hemorrhage. Endovascular of these technologies has created capabilities
MPACT OF IMAGING
myelography and we have almost stopped In the future, Dr. Sosna predicts, 3-D reconstruction
doing diagnostic angiography – the CT and the MRI will be even more efficient. Now it takes 30 to 60
can do the same thing noninvasively. These machines minutes to produce a reconstruction. In the future,
and their sophisticated successors gave us new the computer will do it and there will be computer-
capabilities and have led to new devices and aided detection, as well, he said. “The computer
new techniques. will become a second reader helping us become
“In addition to diagnosing and treating acute strokes
caused by blockage or hemorrhages, sometimes we In many ways, the computer has already helped
can actually prevent strokes from occurring,” Prof. doctors become better doctors, giving patients
a better chance of life and quality of life. The
In another technology-inspired innovation, Dr. Jacob future is fast upon us, bringing new
Sosna, Director of the Dept. of Radiology’s Research technologies that generate new techniques,
and Imaging Laboratories, is using computer- providing images and insights into the body
generated 3-D reconstruction to create a complete that generations of doctors only dreamed of.
picture, using techniques “similar to what is used in
the cartoon industry,” he said. In the 114 years since Dr. Wilhelm Roentgen
discovered the x-ray, imaging machines have
“Before the arrival of the CT, we needed to open the
made light years of progress, producing results
body to know what was going on.” The CT focuses
on the problematic area and produces thin slices of and providing ever-expanding possibilities for
the image. When the slices are reassembled by providing better patient care, treatment and
computer software, the result is a very detailed follow-up.
A 3-D reconstruction obtained from a CT performed multidimensional view of the body's interior. This
on a patient with a complex vascular pathology of can obviate the need for diagnostic angiography In the 97 years since Hadassah was founded,
the abdominal aorta. using dye. the Hadassah Medical Organization has
enthusiastically embraced each new
that are revolutions in their own right – and it “In 1974, each slice took 4 minutes, now each slice
development, often the first to introduce it to
becomes cumulative,” said Prof. Moshe Gomori, Chief takes .03 seconds. With this information we can plan
of Neuroradiology. how to intervene and where to put in stents. With 3- Israel, at times the first in the world to use it in
D, we can see pathology that conventional imaging an innovative way, and sometimes the only
“We have reached the point where we can eliminate doesn’t show. We can also generate a movie picture Israeli medical center that takes imaging far
some invasive diagnostic procedures such as of 1,000 to 2,000 images.” beyond the imagination.
GIFTS FROM THE HEART
A FAMILY AFFAIR A SPECIAL GIFT FOR A
In recognition of the unique role of the Russell
and Patricia Fleischman Center for Women’s Patients from the Dyna and Fala Weinstock
Health, Sheldon and Marion Gumprecht Dept. of Pediatric Hematology and Oncology
Portman of Las Vegas NV decided to donate a and their families often gather in the enclosed
patient waiting room. balcony adjoining the department for rest and
relaxation and quiet conversation. Equipped
During a visit to Israel, their daughter, with a television, special patient chairs and
Dr. Michelle Portman-Rozin dedicated her food facilities and a magnificent and soothing
parents’ gift in the presence of her family. Prof. view of the surrounding Judean Hills, the
Amnon Brzezinski, Head of the Russell and balcony provides a respite from the hospital
Patricia Fleischman Center for Women’s Health, Ben and Ruth Nathanson celebrate the setting. During a visit to Israel, Rabbi Suzanne
gave them a private tour of the facilities and dedication of their Cornerstone Contribution and Andy Offit of West Newton MA, Hadassah
described its unique features. Sheldon and to the Sarah Wetsman Davidson Tower with Guardians of the Dream, dedicated the Day
Marion Gumprecht Portman are Hadassah Prof. Shlomo-Mor-Yosef. Care Balcony in the Charlotte R. Bloomberg
Guardians of Life. Mother and Child Center, and enjoyed a special
CARING CORNERSTONE tour of the entire department.
Surrounded by their children and
grandchildren, Ruth and Ben Nathanson of
Bala Cynwyd PA, Hadassah Guardians of
Tomorrow, received a model of the cornerstone
that will be incorporated into the foundation
of the new Sarah Wetsman Davidson Tower.
At the special ceremony, Prof. Shlomo Mor-
Yosef described their family’s multi-
generational devotion to the Hadassah Medical
Organization and the many important projects
Dr. Michelle Portman-Rozin with Prof. Amnon that have been funded through their generosity.
Brzezinski at the dedication of the Sheldon The cornerstone is in honor and in memory of Rabbi Suzanne and Andy Offit at the dedication
and Marion Gumprecht Portman Patient Mrs. Nathanson’s late parents, Bessie and Louis of the Day Care Balcony in the Dept. of Pediatric
Waiting Room. Stein, Hadassah Guardians of Zion. Hematology and Oncology.
A GENEROUS AND CARING BEQUEST
Annabelle Yuval, Hadassah-Israel's liaison to HMO,
presided over the dedication ceremony honoring
the generous bequest of the late Miriam and Moshe
Sidewater of Kfar Saba, Israel, to the hospice in the
Dept. of Pediatric Hematology and Oncology.
Hadassah-Israel National President Norma
Potashnick, members of the Vered Hasharon
Chapter, including the President, Deborah Netzer,
relatives of the Sidewaters and friends, participated
in the ceremony.
Countless doctors, nurses, senior staff, members
of the HMO administration and friends filled the
Abbell Synagogue to honor Bea Birnbaum, former
Hadassah International Director of Development
for Europe. Prof. Shlomo Mor-Yosef and Prof. Jacques
Michel (right), former Director of Hadassah-Mt.
Prof. Eitan Kerem (left), with Dr. Arlene and Dr. Scopus, were among the many who publicly praised
Sheldon Bearman at the dedication of The Bearman her efforts, accomplishments and decades of
Pediatric Intensive Care Unit. devotion to the Hadassah Medical Organization.
HELPING STEM CELL RESEARCH
HELP AND HOPE FOR Prof. Benjamin Reubinoff, Head of Hadassah’s
SICK CHILDREN Human Embryonic Stem Cell Research Center,
gratefully acknowledged Hadassah-Israel's gift to
Prof. Eitan Kerem, Head of the Department of promote research. From left, Past President Phyllis
Pediatrics at Hadassah-Mt. Scopus and other Levinson, President Norma Potashnick, Prof.
staff members joined Dr. Arlene and Dr. Sheldon Reubinoff, Past President Miriam Griver, Past President
Bearman of Baltimore MD, their family and Ora Sela and Past President Annabelle Yuval.
friends at the moving dedication of the Bearman
Pediatric Intensive Care Unit at Hadassah-
IN LOVING MEMORY
The special unit, funded by the Herbert Bearman
Foundation and donated in memory of their Diana Schwartz of Boynton Beach FL, with Dr. Yair
daughter, Jill Kerri Bearman, is specially equipped Birnbaum, HMO Associate Director General and
and designed to bring help and hope to children Director of Hadassah-Ein Kerem, after the ceremony
in times of distress. The Bearmans are members of honoring her late husband, Dr. Sy Schiowitz, a
Hadassah’s Society of Major Donors. physician in the Hadassah Personnel Clinic.
Prof. Shlomo Mor-Yosef with Temple Oheb Prof. Mor-Yosef greets Harold Grinspoon of Andrea and Moshe Silagi of Encino CA,
Shalom of Baltimore MD mission participants, West Springfield, MA, his daughter, son-in-law Hadassah Guardians of Hope, and their friends,
Amy and Steve Burwen, the daughter and son- and granddaughter, Alissa, Steven and Jillian Dr. Robert Adler and Lexi Deutsch Adler of
in-law of Stewart and Marlene Greenebaum of Korn. Mr. Grinspoon and his wife, Diane Malibu CA (right), during their recent visit to
Owings Mills MD. Mr. and Mrs. Greenebaum Troderman, are members of Hadassah’s Society Hadassah-Ein Kerem. Mrs. Silagi is Coordinator
are Hadassah Guardians of Hope. of Major Donors. of National Hadassah’s Development Division.
Arnold Simon, of Colorado Springs CO, a Sharon and David Shine of Boca Raton FL, Stephen Seltzer of Lantana FL, a member of
Hadassah Guardian of the Dream, by the were joined by a pediatric clown in the Dept. Hadassah’s Society of Major Donors and
plaque recognizing the gift of a veranda he of Pediatric Oncology and Hematology at executor of the estate of Dorothy Lasky, by the
and his late wife Wilma gave to the Outpatient Hadassah-Ein Kerem. Mr. and Mrs. Shine are wall honoring Hadassah Guardians. The late Mrs.
Floor in the Sharett Institute of Oncology. Hadassah Guardians of the Dream. Lasky was a Hadassah Guardian of the Dream.
NEW CLINIC FOR MEN
For the first time in Israel, men
with viral diseases such as
Hepatitis C and HIV have the
possibility of having healthy
children using an innovative
treatment – washing their
sperm. The new clinic was
made possible through the
through the cooperation
Gail Stoll of Patchogue NY, Adrienne and Sanford Eckerling Marla Dan of Toronto, National between Hadassah’s Clinic for
visited the Helipad donated of Highland Park IL, their President of Canadian HIV Research, Dr. Philippe
by her in-laws Harry and children and grandchildren, Hadassah-WIZO, pointing to Halfon, director of a similar
Helen Stoll of East Patchogue, recently toured Hadassah-Ein the contribution she and her center in Marseille, France, Prof.
NY. Helen and the late Kerem. They are pictured by their husband, Aubrey, made to the Raymond Schinazi of Emory
Harry Stoll are Hadassah names on the wall of Hadassah’s Judy and Sidney Swartz Center University in Atlanta GA and
Guardians of Life. Society of Major Donors. for Emergency Medicine. the Puah Institute for Fertility
and Gynecology according to
Melissa Zales Koller and her
husband, Tim, of Weston, CT,
(front row) recently toured
Hadassah-Ein Kerem, with
their children Katherine,
Juliana and Emily, and (back
row)family members Ruth
Zales and Samuel Zales of
Tucson AZ. Mr. and Mrs.
Dr. Bruce and Mady Donoff Orly and Liat Tamir and their Dr. Jeff Horwitz of Austin TX, Koller are Hadassah
of Chestnut Hill MA, mother Debby, of Shorashim son of Dr. Kenneth and Barbara Centennial Founders. She is
members of Hadassah’s Israel, with the stuffed animals Horwitz of Houston TX, member of Hadassah’s Prof. Mor-Yosef, Dr. Philippe
Society of Major Donors, by donated in honor of Liat’s Bat members of Hadassah’s Society National Board. Ruth Zales, a Halfon of Marseille France, Prof.
their name on the Founders Mitzvah and in tribute to her of Major Donors, at Hadassah- member of Hadassah’s Raymond Schinazi of Emory
Wall at Hadassah-Ein Kerem. grandparents, Dr. Abe and Sue Ein Kerem, where he paid tribute Society of Major Donors, is University in Atlanta GA, and
Mrs. Donoff is the immediate Mizrahi of Mamaroneck, NY, to his aunt, Annette Sondock, the daughter-in-law of their families celebrate the new
past president of the members of Hadassah’s National Chair of the Hadassah Hadassah leader Gladys clinic for men with viral diseases
Boston Chapter and a Society of Major Donors. Mrs. Medical Organization. Barbara Zales, of blessed memory, that will raise the possibility of
member of the National Mizrahi serves on Hadassah’s Horwitz serves on Hadassah’s and Melissa and Samuel, siring healthy children through
Service Committee. National Board. National Board. Gladys Zales’ grandchildren. an innovative new treatment.