Advanced Multimodality Image Guided Operating (AMIGO) Suite
Image-guided Therapy
Imaging has become essential not only for the detection and monitoring of disease but also for improving the outcome of therapy. The overall goal of Image Guided Therapy (IGT) is to help the physician improve the efficacy and reduce the morbidity of minimally invasive procedures by providing intra-operative image based anatomic and physiologic information in real-time. Traditional surgery is based on hand-eye coordination; IGT advances this concept by enhancing what the eye can see with multimodal imaging, and what the hand can do with robotic and therapy devices. IGT integrates therapy with intra-operative imaging and transforms invasive procedures into reduced-risk minimally invasive or non-invasive ones. In IGT, pre-operative and real-time intra-operative image information is displayed, and the technologies for imaging, guidance, and therapy are all integrated within complex therapy delivery systems. In addition, multimodal imaging guides therapies using comprehensive information derived from the different physical and biological characteristics of the tissues in ways that a single imaging modality cannot. Through this fusion of data from various imaging sources, compensations are made for any weakness of an individual modality.
The History of Image-guided Therapy at Brigham and Women’s Hospital
The BWH began its IGT program in 1991. Since then, it has become an internationally recognized pioneer in real-time intra-operative MRI-guided therapy. Using the well-known “double-doughnut” system, BWH teams performed over 3,000 surgical and interventional procedures. By 1994 the BWH IGT Program introduced non-invasive MRI-guided focused ultrasound surgery. Constructed in 2009, AMIGO continues these pioneering efforts with multimodal image guidance.
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| MRT 1991 | Focused Ultrasound Surgery 1994 | AMIGO 2010 |
AMIGO
The Advanced Multimodality Image Guided Operating (AMIGO) Suite is an innovative surgical and interventional environment that is the clinical translational test bed of the National Center for Image-Guided Therapy (NCIGT) at the Brigham and Women’s Hospital (BWH) and Harvard Medical School. The AMIGO is an integrated, 5,700 square foot area divided into three sterile procedure rooms in which a multidisciplinary team will treat patients with the benefit of intra-operative imaging using multiple modalities. In AMIGO, real-time anatomical imaging modalities like x-ray and ultrasound are combined with cross sectional digital imaging systems like CT, MRI, and PET. Molecular image-guided therapy will be pioneered with the use of multiple molecular probes, such as PET, optical imaging, and targeted mass spectrometry, to increase the sensitivity and specificity of cancer detection. Application of these technologies is expected to improve the ability to define tumor margins to more completely excise or thermally ablate tumors. In addition to multi-modality imaging, the AMIGO has various navigational devices, robotic devices, and therapy delivery systems that help physicians to localize and treat tumors and other targeted abnormalities. The AMIGO represents and encourages multidisciplinary cooperation and collaboration among teams of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses and technologists to reach the common goal of delivering the safest and the most effective state-of-the-art therapy to patients in a technologically advanced but patient-friendly environment.
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| PET/CT Room
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. | Operating/Angiography Room (OAR)
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. | MRI Room
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. |