Intra-operative imaging has been helping surgeons work on patients with greater confidence and increased precision.
We had a chance to ask Amy Boyle, Executive Vice President, Marketing at IMRIS, about the benefits of intra-operative imaging, and specifically about the company’s VISIUS Surgical Theatre that comes with either CT or MRI scanner that can quickly slide in and out of the OR to image the patient on the table as needed.
Justin Barad, MD, Medgadget: There are great examples of where intra-operative MRI can alter surgical decision making. Can you provide some examples of how you have found intra-operative CT to be helpful?
Amy Boyle: MRI is the imaging modality of choice for soft tissue differentiation. CT is the imaging modality of choice for boney structures. Therefore iCT will allow surgeons to assess positioning of hardware in bone (like pedicle screws) for ultimate accuracy during the surgery rather than after. The literature (cited below) shows iCT is effective in guiding decision making on the optimal placement of pedicle screws as an example.
We do not currently have any IMRIS data on intraoperative CT as we are currently in the install phase of our launch customer Duke, to be completed by January 2013.
We do expect similar results for neurosurgical applications (for cranial and spinal work performed by neurosurgeons) where the IMRIS approach (vision) is to seamlessly integrate CT imaging within current surgical workflows. This will ultimately result in better patient treatment and clinical workflow.
Larson et al. reported that over 3% of pedicle screws implanted for spinal deformity were revised because of intraoperative CT imaging.*
In DBS clinical cases CT scanning is the modality of choice for post-operative lead placement /positioning confirmation. With the VISIUS Surgical Theater integrated with a CT will give the clinicians the flexibility to control lead positioning intraoperatively prior to discharging patients.
From our experience for bringing intraoperative MR to neurosurgery, the clinicians adjusted their clinical approach post-imaging up to 40%. We project that with iCT will give physicians additional information to adjust their approach during the surgery.
Medgadget: What hospitals are currently using/planning to use the VISIUS surgical theatre?
Boyle: Please see this attached presentation (PowerPoint)…
Medgadget: What kind of feedback have you received from surgeons, anesthesiologists and other OR staff on your operating theatres?
Boyle: The following are the testimonials from real clinicians:
“VISIUS Surgical Theater has improved our ability to safely and more completely remove brain tumors, and has become an integral part of what we do every day in our neurological practice.” M. Chicoine, MD
“We have six surgeons in our group, all doing elective cranial interventions in the VISIUS Surgical Theatre [formerly the IMRISneuro suite]. We have completed over 500 cases, including catheter placements, brain tumors and epilepsy surgeries. Image quality is tremendous, and the system has really lived up to its billing.” J. Kennedy, MD
“The IMRIS iMRI solution has enhanced neurosurgery today. Approaching 1300 procedures, high resolution imaging helps achieve the best possible surgical outcomes for our patients.” G. Sutherland, MD
“We selected IMRISneuro because we believe it is the most effective intraoperative MRI solution available globally. IMRIS has significantly advanced our neurological capabilities, and the system is contributing directly to our hospital’s reputation as a world class facility.” X. Bainan, MD
Anesthesiologists, while not quoted here, have reported to strongly prefer NOT moving the patient as it maximizes integrity of all of the patients airway and lines.
Medgadget: Can you comment on how your specific set-up differs from similar intra-operative MRI products/suites currently on the market?
Boyle: The VISIUS Surgical Theatre is the only system that does not move the patient. Because the imaging technology comes to the patient and over the end of the table, the patient position remains unchanged. This is enabled because the VISIUS Surgical Theater is the only product of its kind that connects multiple surgical and imaging environments/rooms through a ceiling mounted rail system. The product integrates all necessary components from IMRIS and other vendors into a seamless environment that improves ease-of-use for clinical teams for various clinical applications.
Medgadget: We love smartphones/tablets here at Medgadget; is there any iPhone/iPad or other similar device integration in your OR suite?
Boyle: Yes. There is an iPod docking station to provide music integration throughout the suite, and there are also touch screens in the Theatre.
Medgadget Can you comment a little more on how your OR suite will provide for navigation-guided neurosurgery. Do you have your own proprietary system or will it interact with third-party systems like BrainLAB?
Boyle: We have an enabling OR suite where customers are able to use third party navigation-guided systems to help in neurosurgical cases if they wish. We also have our own patented image guidance system approved in Canada and Europe that is seamlessly integrated within the suite. The VISIUS Surgical Theatre allows for updated imaging intra-operatively from which to navigate.
* Larson et al., Pediatric Pedicle Screw Placement Using Intraoperative CT and 3D Image-Guided Navigation, Spine, July 5 2011
Product page: VISIUS Surgical Theatre