Medicine: Radiating Knowledge
One of Israel’s leading oncological radiologists is also a medical world traveler, journeying from New York to Hadassah Hospital in Jerusalem, even teaching in Oceania.
She is almost a Hollywood stereotype. With her glasses on, her hair tied tightly back and her starched white doctor’s coat, she is central casting’s dedicated scientist. Then she loosens her hair, the glasses come off and you see a warm, laughing and attractive woman, as well.
Tamar Sella, 40, physician and coordinator of oncological imaging at the Hadassah–Hebrew University Medical Center Radiology Department in Jerusalem, leaves the Hollywood typecast far behind. Happily married for 16 years and an involved mother of two preteen daughters, she is also a former dirt biker (which is how she met her husband). With bikes exchanged for a jeep, she relaxes by exploring Israel with her family and getting dirt under her fingernails tending their small orchard outside Jerusalem.
In addition to all this, of course, is her fast-track medical career: Dr. Sella is one of Israel’s leading oncological radiologists, introducing into the country, for example, a new and sophisticated diagnostic test for prostate cancer—the endorectal coil. She is also known far beyond Israel’s borders, from the academic conference circuit and the professional articles she publishes regularly to the Republic of Palau in Oceania, where she was sent this year to set up a diagnostic radiology training program.
“I never planned to go into medicine,” she recalls. “Growing up as a doctor’s daughter, I’d decided early on that I wouldn’t be following my dad. But he encouraged me. ‘It’s a profession in which no two days will look alike,’ he used to say. And he was right.”
Dr. Sella’s father is the renowned Dr. Zvi Fuks, chair of the Department of Radiation Oncology and head of the Metastatic Cell Biology Laboratory at the Memorial Sloan-Kettering Cancer Center in New York. The demands of his career framed his daughter’s childhood. She was born in Tel Aviv but lived in California from age 4 to 11 while her father worked at Stanford University School of Medicine—and she still speaks fluent American-accented English.
During her high school years, Dr. Fuks was chief of oncology at Hadassah, so she studied in Jerusalem at the well-regarded Leyada, the Hebrew University High School, a semiprivate Jerusalem institution. When Dr. Fuks moved to Sloan-Kettering, she enrolled at Columbia University in New York before returning to Israel to study at the Hebrew University–Hadassah Medical School. “At med school, I leaned toward radiology,” she says. “I liked it because it’s such a broad topic in which you get to see a bit of everything….”
Another attraction of radiology was its rapid development. “It was clear, even then in the early 1990’s, that the role played by technology and computing in radiology would only get stronger, and this would revolutionize the field,” she says. “I’d be working at the forefront of research and development. It also combined two of my great enthusiasms: medicine and computers.”
The births of her daughters, Adi, 12, and Noa, 9, were fitted around her internship—one pregnancy completed near the beginning and the other begun near the end—so her babies would not be exposed to radiation nor would her studies be compromised. She recalls her residency in Hadassah’s Department of Radiology as a frantic time.
It was here that her professional future became clear. “At the beginning of my residency, I learned a bit of everything, working under radiology department head Jacob Bar-Ziv and oncological imaging head Yevgeni [Eugene] Libson,” Dr. Sella says. “By the end, I knew that my specific interest was oncological imaging.”
When Dr. Bar-Ziv retired a few years later and Dr. Libson became department head, Dr. Sella, just returned from a fellowship in diagnostic radiology at Sloan-Kettering, replaced the latter as oncological imaging coordinator.
“This is where my medical specialty converged with that of my father,” she says, smiling. “Because Sloan-Kettering is a cancer institute, diagnostic radiology there is essentially cancer imaging. I had the privilege of studying and researching there under Dr. Hedvig Hricak, with whom I remain in close professional contact. Under her guidance, I subspecialized in MRI of the prostate.”
As a result of the fellowship, Dr. Sella introduced into Israel a high-technology diagnostic test for prostate cancer, the endorectal coil, enabling more accurate treatment and improved outcome.
“Prostate cancer is the most common malignant tumor in men, its rate of occurrence similar to that of breast cancer in women,” Dr. Sella explains. “Better detection and characterization of this cancer is a significant step toward improving management of these patients.”
Until recently, the prostate was most commonly imaged by ultrasound and MRI scanning of the pelvis. The gland is so small, however, that very-high-resolution imaging is needed for an accurate picture.
“The results produced were reasonably good, but not good enough,” says Dr. Sella. “In diagnosing prostate cancer, it is crucial to know if the disease is local or whether it’s spread beyond the prostate capsule into the pelvic lymph nodes or seminal vesicles. Surgery is a good option only if it’s still local. If it’s metastasized, recurrence following surgery is very high and other therapies are preferred.
“By combining information from PSA blood tests, digital rectal examination and the biopsy specimen, we would get a fairly good statistical estimate of possible spread. The new technique often replaces probabilities with certainties.”
The $26,000 endorectal coil is a thin wire covered with a balloon. It is inserted into the rectum during a 40- to 50-minute MRI scan, helping produce an exact picture of the disease and its spread. This allows oncologists and urologists to select and aim their instruments against the cancer with pinpoint precision.
Introduced at Hadassah in January 2006, it is as yet the only endorectal coil in use in the country. To date, it’s been used solely for anatomic imaging, but it lends itself to more than this. “It also allows spectroscopic, or metabolic, imaging, which lets us see processes at work inside the prostate,” says Dr. Sella. “We are now recruiting personnel trained in this technique so that we can practice it in the medical center.”
Dr. Sella tests about three patients a week with the coil—both those who come directly to Hadassah and those referred by urologists countrywide. She believes this number would be significantly higher were the $300 cost of the test covered by all the country’s health care funds.
Another of Dr. Sella’s responsibilities is Hadassah’s radiology residency training program; in this capacity, she was sent on an April 2006 trip that drew on both her medical expertise and her love of adventure. “When the Republic of Palau asked Israel to help them set up a diagnostic radiology training program, Israel’s Foreign Affairs Ministry asked me to go, with radiographer Nathalie Greenbaum, Hadassah’s CT-scanning coordinator,” she says. “At the time, I didn’t even know where Palau was….”
The republic of palau, she discovered, is a group of islands southeast of the Philippines whose combined size is slightly more than two and a half times that of Washington, D.C. Its main city, Koror, has a modern 80-bed hospital with radiological equipment, but none of the republic’s 28 physicians is a trained radiologist. Dr. Sella designed a 40-hour continuing-education course to teach them basic image interpretation and medical radiography.
“The Palauans were enthusiastic about our visit and very open and warm toward us,” says Dr. Sella. “They were also very responsive students. Even during the two weeks we were there, we saw improvement in their radiological skills. The relationship we formed with them continues with ongoing consultation via e-mail.”
Back at Hadassah, she also acts as a researcher. “There’s a lot going on in the department,” Dr. Sella says. “We are continuing our research in MRI of prostate cancer, but we’re also working on novel CT-imaging techniques to improve the way we see things—exploring, for example, the effect of different contrast materials. This developing technology allows faster and more accurate imaging.”
One aim of the department is the creation of an advanced-imaging laboratory for both imaging and translational imaging for clinical purposes.
“Clinical aspects of imaging are receiving increasing emphasis at Hadassah,” Dr. Sella says. “We’re working intensively to develop guided semi-invasive cancer treatment—injecting different therapies directly into the tumor—as well as in different forms of image-guided tumor ablation.”
Like most doctors at Hadassah, says Dr. Sella, she sees herself “as part of further technological advance.
“We’re very hopeful,” she adds, “about making a breakthrough.”