by Lisa Chamoff
, Contributing Reporter | April 29, 2017
From the April 2017 issue of HealthCare Business News magazine
Intraoperative imaging equipment has become an important way for neurosurgeons to oversee thermal ablations and ensure more complete tumor resection, though ways of integrating the equipment into the OR can vary.
Dr. Walter Hall, a neurosurgeon at SUNY Upstate Medical University, says that at the facility’s cancer center, a 3-Tesla MRI scanner is stationed in a separate room next to the OR, where it is used several times a week during procedures, to track the temperature of thermal ablations and check the extent of tumor resection, as well as for routine imaging. Hall also utilizes functional MRI prior to a procedure to determine how close motor and speech functions in the brain are to a tumor.
In a room adjacent to the MR scanner is a Siemens biplane angiography suite, where surgeons clip aneurysms and perform post-clipping angiography. This setup is different from systems offered by IMRIS Deerfield Imaging, which enable ceiling-mounted intraoperative MRI systems. Hall says having the imaging equipment in an adjacent room is preferable in order to get the best return on investment while ensuring a sterile environment in the OR.
The IMRIS Deerfield Imaging system is “very, very popular, but it’s primarily for surgical use,” Hall says. “It does require additional time because you have to bring the magnet in and take the magnet out.” The Philips 3-T magnet that SUNY Upstate has is unique, in that they can slide a patient in from either end. With the MR scanner in a separate space, “patients have access to the MRI scanner without going through the operating room,” Hall says.
The three-room intraoperative suite is next to the facility’s Gamma Knife center, and before all such radiosurgery treatments, the patients undergo an MR scan with a head frame. Appropriate measures must be taken when incorporating high-tech radiology equipment into an OR environment. “In general, when you end up taking an OR, which has very strict requirements for being an OR, with air circulation in a certain direction, that environment is unique,” Hall says. “In that suite, the equipment doesn’t move. You have to be able to orient the table so you can do your surgeries and rotate the table to the point where you can do your angiogram successfully.
The nurses, suction equipment [and] cautery equipment [are] going to have to be placed according to [the] angiogram table and MRI couch. The setup requires a little more thought and preparation.” “We either use the standard couch that comes with the magnet, or go in through the opposite side,” Hall says. “It’s a straight-on placement of the patient. You don’t have to go around [the] magnet and place the person in head first.” While some neurosurgeons prefer the magnet being brought to them, as with the IMRIS Deerfield Imaging VISIUS iMRI system, Hall considers his facility’ current setup more manageable.
“Would you rather move a 200-pound patient that’s asleep on a gurney to the MRI couch, or would you rather bring a 2,000-pound magnet across a room?” Hall says. While Hall says some other surgical specialties, such as urology, have been slower to adopt intraoperative imaging, it has been crucial to improving patient outcomes. “If you get a more complete resection and the patient doesn’t experience post-op swelling, they spend less time in [the] ICU and go home sooner,” Hall says.