The Magnetic Resonance Imaging (MRI) room will be centered around a high-field (3 Tesla) wide bore (70 cm) MRI scanner integrated with video monitors, surgical lights, therapy delivery equipment, an MRI-compatible anesthesia machine, and vital signs monitor. Here, the clinical team will extend image-guidance principles from neurosurgery to many oncology applications. Initial procedures that will use the MRI in AMIGO include needle-based procedures such as soft tissue biopsy (liver, prostate, etc.), prostate brachytherapy, laser ablation of brain tumors, and percutaneous ablations of soft tissue tumors (liver, kidney, etc.). Catheter-based endo-vascular interventions, such cardiac ablations to treat arrhythmias, will utilize both MRI-guidance as well as angiography. The ceiling mounted MRI scanner can be moved out of the MR room and into the operating/angiography room. With this innovation, the patient does not need to be transferred into the operating/angiography table for MR imaging. The familiar “in-out” paradigm can also be used in which the patient is imaged and then withdrawn from the bore of the scanner for intervention. In some procedures, the doctor can reach into the scanner’s short/wide bore to access the patient. These features enable flexibility in workflow to tailor procedures to the needs of the doctor and patient.

The heart of the AMIGO suite, the operating/angiography room (OAR), is outfitted with a state-of-the-art, electronically controlled patient table surrounded by imaging modalities and therapy devices, including a ceiling-integrated navigation system, a fluoroscopy unit, 3D ultrasound, and a near-infrared imaging system. The patient table top can be changed to optimize the procedure for surgery or angiography. All images and data pertinent to the procedure are collected using video integration technology, prioritized, and then displayed on large LCD monitors at points of use in all three rooms in the suite. Procedures performed in this room will include open surgeries of the brain, skull base, spine, breast, chest, abdomen and pelvis as well as catheter-based cerebro-vascular, peripheral vascular, and cardiovascular interventions guided by both x-ray angiography and MR imaging. Endoscopic and robot-assisted procedures will for the first time be enhanced with the fusion of real-time endoscopic views and virtual endoscopic views constructed from MR or CT images. This novel approach will enable the clinician to see beyond the surface and should improve the safety and efficacy of these minimally invasive therapies. Above all, the AMIGO will provide a sophisticated, fully integrated image-guided therapy infrastructure that will lead to disruptive changes in procedural paradigms of surgery and interventional radiology.

One of the most innovative features of the AMIGO is the inclusion of Positron Emission Tomography (PET), an invaluable molecular imaging modality that reveals functional and metabolic activity. The co-location of a PET/CT scanner in this suite will for the first time introduce molecular imaging into therapy and surgery. The integration of anatomical information from CT and MRI with the functional and metabolic information from PET will inform surgical decision making during tumor resections and percutaneous thermal ablations. Using this technology, we envision that physicians can localize and target viable tumor tissue before a procedure and verify the completeness of surgical removal or destruction of tumors by depicting any residual cancer tissue prior to the end of the procedure. Under research protocols, our team will develop image-guided procedures enabled by novel molecular imaging agents generated in the BWH’s state-of-the-art cyclotron. Using integrated patient transfer technology, the patient, monitoring, and anesthesia delivery equipment can efficiently move from the PET/CT table to the operating/angiography room table. The marriage of a procedure room with a molecular imaging environment will accelerate the validation of new contrast agents as well as enhance clinical decision making.