Designing the smart operating room of the future

Transcription

1 Designing the smart operating room of the future Michael Halle, PhD Surgical Planning Lab Brigham and Women s Hospital a teaching affiliate of Harvard Medical School

2 AMIGO video 2

3 AMIGO: Image guided therapy suite 3

4 Advanced Multimodality Image Guided Operating Suite AMIGO is an innovative surgical and interventional environment where real-time anatomical imaging modalities like x-ray and ultrasound are combined with cross sectional digital imaging systems like CT, MRI, and PET. AMIGO technology improves the ability to define tumor margins to more completely excise or thermally ablate affected areas. AMIGO is a multimodality, multidisciplinary, and multivendor translational environment. PET/CT Room Integration of anatomical info from CT and MRI with functional and metabolic info from PET informs surgical decision making during tumor resections and percutaneous thermal ablations. Operating Room The OR is outfitted with an electronically controlled patient table surrounded by imaging and therapy devices (ceiling-integrated navigation system, fluoroscopy, 3D ultrasound, and a microscope with near-infrared imaging system). MRI Room Room contains a 3T MRI fully integrated with video monitors, surgical lights, therapy delivery equipment, an MRI-compatible anesthesia machine, and vital signs monitor. A ceiling mounted MRI scanner can be rotated or moved into and out of the OR and MR rooms. 4

5 AMIGO floor plan 530 sq. meters 5700 sq. feet MRI Equipment Storage Crash Area Control Area Instrument Processing Flow Coordination OR/Cath Lab Anesthesia Storage PET/CT Sterile Storage

6 AMIGO location planning

7 AMIGO s strengths See the results of surgery remove the all tumor, leave healthy tissue untouched Track surgical instruments, merge with pre-operative scans Guide biopsy, brachytherapy, ablation treatment Add any combination of image modalities to surgery Explore new medical ideas and procedures in a framework emphasizing patient safety 7

8 1630 AMIGO Procedures 08/30/ /12/2017 Neurosurgery 303 Interventional Radiology 1121 Brain Tumor Resection 166 ABLATION 589 Deep Brain Stimulation 61 Transsphenoidal Pituitary Tumor Resection 25 Brain Tumor Laser Ablation 17 Brain Biopsy 13 Skull Base Surgery 9 Breast Conserving Surgery 33 MR Prostate 19 Video-Assisted Thoracoscopic Surgery 28 Lung 24 Endocrine Surgery 9 Spine 25 Spine Discectomy and Fusion 2 Head & Neck 19 Cardiac EP Ablation 7 BIOPSY 537 Radiation Oncology 110 MR Prostate 445 Gynecologic HDR Brachytherapy 100 MR, PET CT Lung 27 Prostate VLDR Brachytherapy 10 Transarterial Chemoembolization 1 8

9 The father of image-guided therapy Ferenc A. Jolesz Scientist, Engineer, Surgeon, Radiologist 9

10 Inventing image guided therapy AMIGO represents the latest step in IGT research at BWH started in the early 1990s MRT MRgFUS NCIGT AMIGO 1991 BWH Image-Guided Therapy Program founded by Ferenc Jolesz Introduction of world s first inter-operative MR magnet: MRT double-donut 1994 BWH develops first MRguided Focused Ultrasound (MRgFUS) therapy system 2005 Creation of NIH-funded National Center for Image Guided Therapy IGT applications expand to other advanced imaging modalities 2011 AMIGO: First suite to offer the full array of advanced imaging modalities in one operating theater (MRI, PET/CT, 3D US, Fluoro, Angio) Since the early/mid-1990 s, over 100 interoperative MRIs and close to 100 MRgFUS systems have been installed worldwide. Training and technology dissemination: eg, 3D Slicer A clinical and translational test bed for multi-modal IGT Slide courtesy T. Kapur 10

11 The vision of the future OR is Give the surgeon super powers : Super vision Super senses Super accuracy fmri and DTI in OR Most important: Power to heal 11

12 The surgeon sees the surface Only through experience does the surgeon know what lies below the surface Where is the carotid? Where is the optic nerve? Courtesy A. Nabavi Before resection 12

13 and is responsible for the patient Is the entire tumor removed? Is everything else untouched? Carotid Artery Optic Nerve left Frontal Lobe Optic Nerve right Basilar Artery Tumor resected? Courtesy A. Nabavi 13

14 The radiologist sees below the surface Many techniques to see inside the body MRI, CT, PET, fluoroscopy, ultrasound, mass spectometry, Courtesy A. Nabavi 14

15 Image guidance gives surgeon super vision Provided by Leventon et al. Surgical Planning Lab optical tracking and registration (early 1990 s) 15

16 Connecting the operating room OpenIGTLink protocol allows OR devices to communicate Intraoperative imaging Optical tracking devices Robotic devices Commercial and research Status Navigation software Command Scanner Tracking devices Robot Slide courtesy J. Tokuda 16

17 Image Guidance today: Parathyroid adenoma Small glands hidden behind the thyroid gland Regulates calcium Numerous sensitive structures in vicinity Recurrent laryngeal nerve carotid arteries Slide courtesy J. Jayender 17

18 MR-Guided Parathyroidectomy DCE-MRI of Parathyroid Adenoma Surgical Planning Patient positioned with imaging coil Fiducials placed on patient 18

19 MR-Guided Parathyroidectomy Jayender J, Lee TC, Ruan DT, Real-Time Localization of Parathyroid Adenoma during Parathyroidectomy, NEJM,

20 Gynecologic Interstitial Brachytherapy Cervical, endometrial, and vaginal/vulvar cancers second most common cause of cancer third most common cause of death in women Treat the tumor using radioactive seeds in hollow needles 20

21 Gynecologic Interstitial Brachytherapy Needle Labeling for Interstitial Gynecological Brachytherapy. Gao, Farhat et al. 21

22 AMIGO: a surgical laboratory Develop new procedures, safely Needs an dedicated interdisciplinary team Surgeons & Radiologists Engineers/Computer Scientists Technicians Nurses Deploy to other advanced operating rooms Many tools, not always most advanced tools Not for every hospital 22

23 Acknowledgements Clare Tempany MD (Director) Tina Kapur PhD (Executive Director) Ron Kikinis MD Sandy Wells, CF Westin, N. Hata, S. Warfield, R. San Jose, E. Grimson, P. Golland, S. Bouix, Y. Rathi, A. Fedorov, L. Odonnell, A. Tannenbaum, S. Aylward, W. Loresen, S. Pieper, G. Gerig, G. Szekely, G. Fichtinger, and many others M. Shenton, C. Guttmann, P. Black, H. Weiner, M. Albert, D. Altobelli 23

24 Questions? 24