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Ron Terry, R.T., and Jennifer Milinowicz, R.T., prepare a patient for TomoTherapy treatment, which allows a higher dose to the tumor without an increase in side effects. Several other options are available, including 3-D radiation therapy, image-guided radiation therapy, intensity-modulated radiation therapy, respiratory motion management, brachytherapy and intraoperative radiation therapy. ulcerative colitis and familial polyposis and involves removing the large intestine and rectum. The surgeon then creates a new pouch from the small intestine that is then connected to the anus. The coloanal anastomosis procedure addresses low-lying rectal cancers by essentially dissecting and excising the tumor through the anal canal, thus eliminat- ing the need for an abdominal incision. "Very often, we can avoid a permanent colostomy and also spare nerves that control sexual function to preserve quality of life after the operation. We utilize the laparoscopic approach whenever possible," says Dr. Nitzkorski. "We're also developing a protocol for TEM resection of tumors. Very few centers offer that for completely scarless rectal surgery for early stage rectal cancers and polyps." The TEM resection procedure — used to treat colon and rectal masses — employs a colonscope with a tubular fitting attached to the end that provides enhanced magnification of the small nerves in the rectal area and the specialized instrumentation needed to perform finite surgery in small spaces. Although still in the planning stages, this technique offers another avenue of treatment through a natural orifice rather than a surgical incision. From the Brain to the Body Matching the surgical oncology services are the radiation oncology treatments available at Health Quest. A team of board-certified radiation oncologists, oncology-certified nurses and therapists, and the dosimetrists and physicists responsible for the technical elements of care deliver a range of external beam modalities, including three-dimensional conformal radia- tion therapy, image-guided radiation therapy, intensity-modulated radiation therapy, respiratory motion management and TomoTherapy. In addition, Dr. Farhangi and his colleagues perform brachytherapy and intraoperative radiation therapy (IORT). Both therapies are performed intraoperatively and involve the targeted delivery of radiation to the PHYSICIANS IN THE LEAD A MAJOR SHIFT in philosophy is underway throughout the Health Quest system. The health care system is redesigning the decision-making process within not only its oncology service line, but also each hospital and the system as a whole. The Physician Leadership Council and the Cancer Committee at each individual hospital establish a forum in which physicians are more closely integrated with administrators in long-term strategic planning and the recognition of short-term needs and challenges. "Clinicians are the ones who are there at the front lines working every day. They can identify their needs and their patients' needs, and that can better inform the decision making of the hospital administrators," says Edward Farhangi, M.D., radiation oncologist, Medical Director of Radiation Oncology at Health Quest. "We are still early in the process, but so far, I think it's been a really positive step." The overarching assembly — the Physician Leadership Council — helps facilitate discussions between the clinical side and the administrative side of Health Quest in an effort to answer questions regarding key specialty services to develop, major capital investments in equipment, and, ultimately, where the health system should and can be in the next five and 10 years. At the local hospital level, the Cancer Committees mirror the larger body in compo- sition, but each is concerned with the needs and plans of its respective hospital, patients and physicians. This dual initiative will soon involve specialties outside of oncology and continue the process of incorporating physician perspective into the progress of health care throughout the Health Quest system. MDNEWS.COM ■ MD NEWS Mid Hudson | 17 SPECIAL CLINICAL SECTION: ONCOLOGY