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February 19, 2015

WSJ: Intraoperative imaging gaining traction

Daily Briefing

Intraoperative imaging—which involves the use of CT scans and MRIs to let surgeons see inside patients as they operate—is gaining ground as a tool to enable more precise and effective surgeries, the Wall Street Journal reports.

The machines are placed in specially equipped operating rooms, devoid of metal that could interact with the high-powered magnets contained in an MRI machine. Experts say they allow surgeons to avoid damage to healthy tissue, spot complications like blood clots, and excise entire tumors to avoid repeat procedures.

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Intraoperative imaging was first used for complex brain surgeries, but more hospitals are using real-time imaging to aid in spinal surgery and tumor removal. In the case of brain surgery, research has found surgeons modify their surgical plan based on real-time imaging about 40% of the time. "This is precision medicine at its best," says Clare Tempany, co-director of the Advanced Multimodality Image-Guided Operating Suite program (AMIGO) at Brigham and Women's Hospital.

Sohail Mirza, medical director of the Center for Surgical Innovation and chair of orthopedics at Dartmouth-Hitchcock, says intraoperative imaging helps "get past the limitations of human error and hand-eye coordination." Dartmouth opened a set of new ORs last year that have MRI machines and CT scanners mounted on the ceiling to aid in such procedures.

Since opening in 2011, AMIGO has used intraoperative imaging on 700 patients, including for breast-conserving tumor removal. Nearly half of women who have the surgery need subsequent follow-up operations to remove remaining cancerous tissue. Surgeons at AMIGO are working to reduce the need for follow-up by using real-time imaging and chemical analysis to ensure growths are removed on the first try.

Mirza also adds that real-time imaging is less disruptive for surgeons. In the past, he may have wheeled patients to another floor—even stitching them up between trips—to get a better look at an area of interest during an operation. Subsequent attempts to revise a procedure based on imaging were not only traumatic for patients, but costly and time-consuming.

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Not a plug-and-play solution

Investing in intraoperative imaging carries a multi-million dollar price tag for hospitals. Imris, which manufactures the surgical theaters used at Dartmouth and Brigham and Women’s, says the MRI units cost between $3 million and $7 million, and the CT scanners cost $1.5 million to $3.5 million. Even so, the company says more than 17,000 procedures have been performed so far using its systems.

Additionally, performing surgery with intraoperative imaging is not a simple plug-and-play affair. Because metal cannot be used in the operating rooms, surgical teams need special training and tools to respond to complications like cardiac arrest, says Bernadette Henrichs, director of the nurse anesthesia program at Barnes-Jewish College (Landro, "The Informed Patient," Wall Street Journal, 2/16).

The takeaway: Intraoperative imaging is gaining ground as a tool for more precise and effective surgeries, but high-cost and special training requirements means hospitals need to be well prepared in order to capitalize on the technology.

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