Mount Sinai School of Medicine Archives

Integration of Augmented Reality (AR) and Extended Reality (XR) into Urology Training and Practice

Posted by Nelson N. Stone, MD | Aug 2023

Nelson N. Stone, MD, examines the immense transformative potential of augmented reality in the realm of surgical education and training. With a comprehensive approach, he dives deep into the concepts of augmented reality, virtual reality, and extended reality, shedding light on their applications within the field of Urology.

Throughout his presentation, Dr. Stone places a strong emphasis on the pressing need for advanced training methods in response to the rapid evolution of technology and the increasing prominence of minimally invasive surgical techniques. He delves into the utilization of simulation models as a crucial tool for training, while also addressing the unique challenges posed by the COVID-19 pandemic and its impact on traditional training approaches.

Venturing further into the realm of augmented reality, Dr. Stone explores the development of wearable headsets that harness the power of augmented reality, along with web-based platforms that facilitate remote training opportunities. He illustrates how augmented reality enables remote training, empowering instructors to provide guidance and facilitating hands-on practice for trainees, regardless of their physical location.

Dr. Stone showcases real-life scenarios, including transperineal biopsy and renal puncture procedures. These examples highlight the tangible benefits of augmented reality in enhancing hand-eye coordination and improving overall training efficacy.
Concluding his presentation, Dr. Stone presents a survey received from practitioners who have experienced augmented reality training. The survey findings underscore the potential benefits of augmented reality in revolutionizing surgical education by fostering enhanced skill development and promoting a more immersive learning experience.

Financial Toxicity: The New Driver of Healthcare Policy?

Posted by Deepak A. Kapoor, MD, FACS | Jul 2023

Deepak A. Kapoor, MD, FACS, discusses the issue of financial toxicity in healthcare, which he believes will shape health policy. He highlights the rising healthcare costs in the United States compared to other OECD countries, emphasizing the increasing burden shifted onto patients. This shift is primarily driven by the formation of healthcare exchanges, leading to higher deductibles, co-payments, and changing insurance plans.

Kapoor reveals that urological tumors account for a significant portion of cancer spending in the United States, exceeding $200 billion annually. Cancer care, in general, poses a profound economic burden, with patients depleting their savings, reducing retirement funds, and delaying medical care due to costs. Disturbingly, one in four cancer patients lose their homes within five years of diagnosis.

Dr. Kapoor emphasizes the disproportionate impact of this economic burden on marginalized populations, including single mothers, low-income individuals, and historically marginalized groups like Blacks and Hispanics. Dr. Kapoor provides an example of how a simple referral to a hospital-based imaging facility can result in significantly higher costs compared to a radiology facility in a community setting.

Combining Therapy with SBRT and Brachytherapy

Posted by Richard G. Stock, MD | Apr 2022

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, discusses the efficacy of SBRT and brachytherapy for treating patients with prostate cancer. He explains that combined SBRT and brachytherapy seems to be particularly helpful for intermediate-risk cancer, with studies showing about a 90% biochemical control rate. Dr. Stock then goes over the rationale for combined SBRT and brachytherapy, noting that brachytherapy combined with external beam radiation therapy (EBRT) at standard fractionation demonstrates excellent and safe outcomes for both intermediate- and high-risk prostate cancer, and SBRT appears to be comparable or better than standard fractionation without increased toxicity. He summarizes the findings of several different studies, explaining that with low-dose-rate brachytherapy and SBRT, researchers are seeing very similar results to using standard fractionation with brachytherapy. Dr. Stock also looks at a recent trial with high-dose-rate brachytherapy with SBRT which found a favorable early toxicity profile and encouraging cancer control outcomes. He concludes that the combination of SBRT and brachytherapy is promising, and the initial clinical impression is that patients tolerate the treatment well.

Does the Radiation Dose Required to Eradicate Local Disease Differ by Gleason Grade Group?

Posted by Nelson N. Stone, MD | Jun 2021

Nelson N. Stone, MD, Professor of Urology, Radiation Oncology, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai and at the Derald H. Ruttenberg Cancer Center at Mount Sinai, discusses the radiation dose requirements for local disease eradication and the implications for focal therapy. He presents studies of external vema radiation and brachytherapy, which both showed that as the radiation dose increased the likelihood of a positive biopsy decreased two years post treatment. Dr. Stone concludes that it does not matter what type of disease the patient has, it matters how much radiation is used to get rid of the disease. Longer term follow up is needed to see the impact of radiation doses. Post-irradiation biopsies imply that a BED of over 240 Gy can eradicate all prostate cancer. If a tumor is small then there is a potential for a high dose of radiation just to the affected regions. Larger tumors or cases with extensive multifocality will require a full dose treatment with a full or partial implant.

Does Anatomic Rectal Displacement Improve Dosimetry and Reduce Injury?

Posted by Richard G. Stock, MD | May 2021

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, reviews the literature on rectal displacement to prevent damage to the rectum from prostate brachytherapy and external beam radiation therapy (EBRT). First, he summarizes the findings of numerous papers from the past 20 years that have identified a relationship between the dose and volume of radiation and damage to the rectum such as bleeding and mucosal changes. The more radiation reaches the rectum, and the greater the surface area of the rectum affected, the more likely patients will experience adverse effects, including greater levels of morbidity. Dr. Stock then considers how the rectum can be spared, focusing on the evidence around rectal spacers such as endorectal balloons and hydrogel spacers such as SpaceOAR. He explains that numerous studies demonstrate that by inserting a physical barrier between the rectum and the prostate, the rectum is kept separate from the radiation and therefore receives a lower rate of toxicity. Dr. Stock notes that patients experience more rectal discomfort with spacers like SpaceOAR than without, but suggests that the reduction of significant issues such as bleeding outweigh the downsides. He concludes by discussing a recent study of his which found that SpaceOAR can be inserted before brachytherapy and EBRT.