The interventional magnetic resonance imaging suite: Experience in the design, development, and implementation in a pre-existing radiology space and review of concepts

Abstract

Background: Intraoperative magnetic resonance imaging (ioMRI) has led to significant advancements in neurosurgery with improved accuracy, assessment of the extent of resection, less invasive surgical alternatives, and real-time confirmation of targeting as well delivery of therapies. The costs associated with developing ioMRI units in the surgical suite have been obstacles to the expansion of their use. More recently, the development of hybrid interventional MRI (iMRI) units has become a viable alternative. The process of designing, developing, and implementing operations for these units requires the careful integration of environmental, technical, and safety elements of both surgical and MR practices. There is a paucity of published literature providing guidance for institutions looking to develop a hybrid iMRI unit, especially with a limited footprint in the radiology department. Methods: The experience of designing, developing, and implementing an iMRI in a preexisting space for neurosurgical procedures at a single institution in light of available options and the literature is described. Results: The development of the unit was accomplished through the engagement of a multidisciplinary team of stakeholders who utilized existing guidelines and recommendations and their own professional experience to address issues including physical layout, equipment selection, operations planning, infection control, and oversight/review, among others. Conclusion: Successful creation of an iMRI program requires multidisciplinary collaboration in integrating surgical and MR practice. The authors’ aim is that the experience described in this article will serve as an example for facilities or neurosurgical departments looking to navigate the same process.

FLASHlight MRI in real time—a step towards Star Trek medicine

“…During the past 25 years several attempts have been made to bring MRI into the operating theater, e.g., see a list of selected examples describing software and hardware tools (14)(15)(16)(17)(18)(19)(20)(21). The present work complements and extends these ideas by describing an acquisition and reconstruction approach for serial imaging which may serve as a universal and robust solution for the MRI part.…”

Intraoperative MR Imaging during Glioma Resection

“…4). [46][47][48][49][50]55,62,72 The latter multi-theater type may extend the transfer distance or require that the scanner is moved into the operating room. 26 The multi-theater type was pioneered by a German group.…”

“…4 ). 46 – 50 , 55 , 62 , 72 The latter multi-theater type may extend the transfer distance or require that the scanner is moved into the operating room. 26 …”

“… 49 In addition, since the separate MR scanner room is completely shielded, it prevents interference with magnetic fields, noise, radio waves, etc., in the operating theater. Therefore, as the throughput of imaging equipment increases and the multi-theater type has high-cost performance, the layout has been adopted in many hospitals, 48 , 49 , 55 , 62 , 63 , 72 , 74 , 75 as sharing imaging equipment has a positive economic impact for hospitals. An increasing number of facilities are introducing imaging devices of different modalities, between which the patient is moved on a tabletop.…”

First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

“…The first intraoperative magnetic resonance imaging (ioMRI) technique was installed in the 1980s [2,3]. The ioMRI technique was first used in neurosurgical procedures to improve accuracy and safety of surgery [4][5][6].…”