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Begley SL, McBriar JD, Pelcher I, Schulder M. Intraoperative MRI: A Review of Applications Across Neurosurgical Specialties. Neurosurgery 2024:00006123-990000000-01101. [PMID: 38530004 DOI: 10.1227/neu.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Intraoperative MRI (iMRI) made its debut to great fanfare in the mid-1990s. However, the enthusiasm for this technology with seemingly obvious benefits for neurosurgeons has waned. We review the benefits and utility of iMRI across the field of neurosurgery and present an overview of the evidence for iMRI for multiple neurosurgical disciplines: tumor, skull base, vascular, pediatric, functional, and spine. Publications on iMRI have steadily increased since 1996, plateauing with approximately 52 publications per year since 2011. Tumor surgery, especially glioma surgery, has the most evidence for the use of iMRI contributing more than 50% of all iMRI publications, with increased rates of gross total resection in both adults and children, providing a potential survival benefit. Across multiple neurosurgical disciplines, the ability to use a multitude of unique sequences (diffusion tract imaging, diffusion-weighted imaging, magnetic resonance angiography, blood oxygenation level-dependent) allows for specialization of imaging for various types of surgery. Generally, iMRI allows for consideration of anatomic changes and real-time feedback on surgical outcomes such as extent of resection and instrument (screw, lead, electrode) placement. However, implementation of iMRI is limited by cost and feasibility, including the need for installation, shielding, and compatible tools. Evidence for iMRI use varies greatly by specialty, with the most evidence for tumor, vascular, and pediatric neurosurgery. The benefits of real-time anatomic imaging, a lack of radiation, and evaluation of surgical outcomes are limited by the cost and difficulty of iMRI integration. Nonetheless, the ability to ensure patients are provided by a maximal yet safe treatment that specifically accounts for their own anatomy and highlights why iMRI is a valuable and underutilized tool across multiple neurosurgical subspecialties.
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Affiliation(s)
- Sabrina L Begley
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joshua D McBriar
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Isabelle Pelcher
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Brain Tumor Center, Lake Success, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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Li W, Li X. Development of intraoperative assessment of margins in breast conserving surgery: a narrative review. Gland Surg 2022; 11:258-269. [PMID: 35242687 PMCID: PMC8825505 DOI: 10.21037/gs-21-652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools. BACKGROUND Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS. METHODS A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into. CONCLUSIONS Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time. Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.
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Affiliation(s)
- Wanheng Li
- First Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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MR Imaging Safety in the Interventional Environment. Magn Reson Imaging Clin N Am 2020; 28:583-591. [PMID: 33040998 DOI: 10.1016/j.mric.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interventional MR imaging procedures are rapidly growing in number owing to the excellent soft tissue resolution of MR imaging, lack of ionizing radiation, hardware and software advancements, and technical developments in MR imaging-compatible robots, lasers, and ultrasound equipment. The safe operation of an interventional MR imaging system is a complex undertaking, which is only possible with multidisciplinary planning, training, operations and oversight. Safety for both patients and operators is essential for successful operations. Herein, we review the safety concerns, solutions and challenges associated with the operation of a modern interventional MR imaging system.
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Pickup L, Nugent B, Bowie P. A preliminary ergonomic analysis of the MRI work system environment: Implications and recommendations for safety and design. Radiography (Lond) 2019; 25:339-345. [PMID: 31582242 DOI: 10.1016/j.radi.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The MRI work system environment in acute hospitals poses a significant risk of harm to patients, healthcare practitioners and others, but knowledge of hazards and potential design improvements are limited as safety research is lacking. The aim of this exploratory study was to understand how the discipline of Human Factors and Ergonomics (HFE) can support the understanding and improvement of safety and performance of MRI working environments. METHODS A multi-method study of two MRI units in Scottish acute hospital settings based on Human Factors and Ergonomics (HFE) principles was undertaken in May 2016. Data collection sources included published literature, local and national safety incident data, site observations and staff interviews which were triangulated and subject to a content analysis. RESULTS A diverse range of system-wide hazards were highlighted which impact on the complexity of MRI work, patient and staff safety and system performance (e.g. adequacy of training and procedures, interactions with equipment, organisation of work). Preliminary recommendations were made to improve system design related to national approaches to safety (e.g. equipment procurement; staff training and procedural standards); interaction design and standardisation (e.g. physical design and barriers, staff uniforms, checking processes); and introduction of MRI passports for patients. CONCLUSIONS This exploratory study suggests the need for national co-ordination and standardisation of MRI safety management strategies, based on safety science and HFE evidence and approaches to improve system design and reduce risk to patients, staff and others. A series of provisional recommendations are offered for consideration.
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Affiliation(s)
| | - B Nugent
- Nursing, Midwifery and Allied Health Professions Directorate, NHS Education for Scotland, Edinburgh, UK; Royal Hospital for Sick Children, NHS Lothian, Edinburgh, UK; Queen Margaret University, Edinburgh, UK
| | - P Bowie
- Safety, Skills and Improvement Research Collaborative (SKIRC), NHS Education for Scotland, Glasgow, UK; Institute of Health and Wellbeing, University of Glasgow, UK.
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Brachytherapy patient safety events in an academic radiation medicine program. Brachytherapy 2017; 17:16-23. [PMID: 28757402 DOI: 10.1016/j.brachy.2017.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the incidence and type of brachytherapy patient safety events over 10 years in an academic brachytherapy program. METHODS AND MATERIALS Brachytherapy patient safety events reported between January 2007 and August 2016 were retrieved from the incident reporting system and reclassified using the recently developed National System for Incident Reporting in Radiation Treatment taxonomy. A multi-incident analysis was conducted to identify common themes and key learning points. RESULTS During the study period, 3095 patients received 4967 brachytherapy fractions. An additional 179 patients had MR-guided prostate biopsies without treatment as part of an interventional research program. A total of 94 brachytherapy- or biopsy-related safety events (incidents, near misses, or programmatic hazards) were identified, corresponding to a rate of 2.8% of brachytherapy patients, 1.7% of brachytherapy fractions, and 3.4% of patients undergoing MR-guided prostate biopsy. Fifty-one (54%) events were classified as actual incidents, 29 (31%) as near misses, and 14 (15%) as programmatic hazards. Two events were associated with moderate acute medical harm or dosimetric severity, and two were associated with high dosimetric severity. Multi-incident analysis identified five high-risk activities or clinical scenarios as follows: (1) uncommon, low-volume or newly implemented brachytherapy procedures, (2) real-time MR-guided brachytherapy or biopsy procedures, (3) use of in-house devices or software, (4) manual data entry, and (5) patient scheduling and handoffs. CONCLUSIONS Brachytherapy is a safe treatment and associated with a low rate of patient safety events. Effective incident management is a key element of continuous quality improvement and patient safety in brachytherapy.
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Terra RM, Andrade JR, Mariani AW, Garcia RG, Succi JE, Soares A, Zimmer PM. Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to --image-guided video-assisted thoracoscopic surgery. J Bras Pneumol 2017; 42:387-390. [PMID: 27812640 PMCID: PMC5094877 DOI: 10.1590/s1806-37562015000000177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 05/09/2016] [Indexed: 11/22/2022] Open
Abstract
The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.
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Affiliation(s)
- Ricardo Mingarini Terra
- . Disciplina de Cirurgia Torácica, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | | | - Alessandro Wasum Mariani
- . Disciplina de Cirurgia Torácica, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | | | - Jose Ernesto Succi
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.,. Disciplina de Tórax, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Andrey Soares
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.,. Centro Paulista de Oncologia, São Paulo (SP) Brasil
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"Low-field" intraoperative MRI: a new scenario, a new adaptation. Clin Radiol 2016; 71:1193-8. [PMID: 27524673 DOI: 10.1016/j.crad.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 05/23/2016] [Accepted: 07/03/2016] [Indexed: 01/24/2023]
Abstract
AIM To describe the adaptation of Cruces University Hospital to the use of intraoperative magnetic resonance imaging (ioMRI), and how the acquisition and use of this technology would impact the day-to-day running of the neurosurgical suite. MATERIALS AND METHODS With the approval of the ethics committee, an observational, prospective study was performed from June 2012 to April 2014, which included 109 neurosurgical procedures with the assistance of ioMRI. These were performed using the Polestar N-30 system (PSN30; Medtronic Navigation, Louisville, CO), which was integrated into the operating room. RESULTS A total of 159 procedures were included: 109 cranial surgeries assisted with ioMRI and 50 control cases (no ioMRI use). There were no statistical significant differences when anaesthetic time (p=0.587) and surgical time (p=0.792) were compared; however, an important difference was shown in duration of patient positioning (p<0.0009) and total duration of the procedure (p<0.0009) between both groups. CONCLUSIONS The introduction of ioMRI is necessary for most neurosurgical suites; however, a few things need to be taken into consideration when adapting to it. Increase procedure time, the use of specific MRI-safe devices, as well as a checklist for each patient to minimise risks, should be taken into consideration.
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Abstract
PURPOSE OF REVIEW The use of intraoperative magnetic resonance imaging (IMRI) during surgeries and procedures has expanded in the last decade. Not only is it becoming more commonly used for a variety of adult and pediatric neurosurgical procedures, but also its use has expanded to other types of surgeries. Along with using IMRI for removing tumors of the spinal cord, surgeons are now using it for other types of surgical operations of the kidney and liver. The increased utilization during the intraoperative period warrants the anesthesia provider to assure that patients and staff are unharmed because of increased risk of the powerful magnet. RECENT FINDINGS Recent literature is reviewed regarding the expansive use of IMRI in the operating and procedure room. Safety issues and anesthetic implications are also addressed. SUMMARY IMRI is becoming increasingly more popular, especially with neurosurgeons, but its use is also expanding to other types of surgeries. Because of the increased use, the anesthesia provider must be aware of the dangers that it imposes to those involved and take necessary safety precautions. This will help assure that no one is harmed during the operation or procedure.
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Childs S, Bruch P. Successful management of risk in the hybrid OR. AORN J 2015; 101:223-34; quiz 235-7. [PMID: 25645039 DOI: 10.1016/j.aorn.2014.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
Abstract
The advent of intraoperative magnetic resonance imaging (MRI) surgery has resulted in numerous advances in minimally invasive procedures. This progress has also revealed serious environmental hazards for the patient and perioperative team. At one facility, implementation of an MRI/OR intervention suite has enhanced surgical care and outcomes. Achieving the benefits of intraoperative MRI can occur with a multidisciplinary, interdepartmental approach to the design and layout of the hybrid environment and through implementation of education and safety protocols, including patient screening and prep for scanning. Personnel, including perioperative nurses, must receive expert hands-on training to successfully mitigate risk and provide care in the hybrid OR setting.
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Tan JKT, Tan TK, Goh JPS, Ghadiali NF. Prospective Review of Safety Incidents Reported in the iMRI OT (Intraoperative Magnetic Resonance Imaging Operating Theatre). PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this study was to determine the types of incidents that occurred in the iMRI OT over a nineteen-month period in our institution. We aim to prevent any future avoidable incidents from happening in this potentially hazardous environment. Methods: This is a single centre prospective non-anonymous observational study conducted from February 2009 to September 2010 on surgeries performed in the iMRI OT. Safety incidents specific to the iMRI OT such as violation of safety protocols and equipment failures were reported as well as any other safety incidents resulting in potential or actual adverse safety outcomes. The outcomes of the incidents were included and the data analysed at the end of the study period. Results: Of 271 cases that were operated in the iMRI OT, 43 incidents were reported by the staff involved in the care of the patient. Of the 43 incidents, 14 incidents (32.6%) were classified as staff/personnel error and were preventable. Incidents resulted in either delayed surgery or cancellation of the surgery. There were no major adverse incidents that led to patient harm. Conclusion: Many of the incidents were preventable and measures have been instituted to prevent the recurrence of such incidents. Staff training, safety protocols and stringent maintenance of equipment are paramount to safe and efficient use of the iMRI operating theatre.
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Affiliation(s)
| | - Tong Khee Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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