From the April 2018 issue of HealthCare Business News magazine

By Dr. Travis Tierney

Putting a 1.5 Tesla magnet into a surgical environment represents a tremendous financial and logistic commitment to excellence in patient care.

Nicklaus Children's Hospital in Miami, Florida made this investment a little over a year ago. The ability to use MR imaging while operating has some obvious advantages, and some that are not so obvious. For example, it is clear in most neuro-oncology cases that complete tumor resection improves the patient's overall progression-free survival. This is perhaps the most common argument made for acquiring intra-operative magnetic resonance imaging (iMRI) capability. A number of open label studies have demonstrated greater gross total resection using iMRI. Indeed, our own experience this year anecdotally confirms that fewer returns to the OR for residual tumor likely occurred. Such an obvious clinical benefit to the child doesn't seem to require emphasizing the idea that one surgery is also less costly than two.

Less obvious advantages of iMRI include increased patient safety. Near real time iMRI allows the surgeons to actually "see" approaches to targets that have been guided in the past by indirect stereotactic coordinate systems. Precise confirmation of biopsy location and placement of intracranial electrodes may avoid multiple passes of probes each of which carries a small but clear incidence of intracranial hemorrhage. We will never know precisely how many adverse events we avoided using the iMRI, but the surgical peace of mind that comes with knowing intra-operatively that no bleeding or stroke has occurred is priceless.

Another advantage of our iMRI is that it is not always being used for surgical cases. During these times we are able to transition the magnet out of the OR to an immediately adjacent imaging bay and use it as a standard diagnostic scanner. This ability reduces scheduling demands on our other dedicated diagnostic units in the radiology department and provides further financial return on the initial cost of the iMRI.

While we are just beginning our experience with iMRI surgery at Nicklaus, there is a strong sense that our initial investments in better patient outcomes and safety have already been met. Perhaps a less recognized but important value to iMRI capability is the potential for enhanced interaction between radiology and surgical colleagues. The chance to exchange ideas in real time in the OR creates an opportunity for exciting professional collaborations beyond the reading and conference rooms. The future will undoubtedly bring new MR-compatible devices and techniques that promise further surgical refinement and safety. Having an iMRI will allow us to be among the first pediatric institutions to evaluate these innovations in children.

About the Author: Dr. Travis Tierney is a Pediatric Neurosurgeon at Nicklaus Children's Hospital

April 2018 Magazine

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