Intraoperative MRI: Safety

Johnston, Thomas; Moser, Robert; Moeller, Karen; Moriarty, Thomas

doi:10.1016/j.nec.2009.04.007

Cited by 25 publications

(9 citation statements)

References 11 publications

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“…8,9 Institutional protocols [10][11][12] and checklists should be prepared 13 and strictly adhered to for each case. 14,15 Continuous data recording and auditing helped us reduce mistakes, personnel requirement, and also time taken to conduct the iMRI. 16 Learning points from our experience in this regard to ensure smooth functioning of the setup have been summarized (►Table 3).…”

Section: Discussionmentioning

confidence: 99%

Setting Up Workflow of an Intraoperative MRI Unit: A Single-Centre Experience of First 53 Cases

Mohapatra

Balasubramaniam

Rao

et al. 2018

Journal of Neuroanaesthesiology and Critical Care

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Background Setting up of a new “nearby” operation room type intraoperative magnetic resonance imaging (iMRI) unit poses a unique set of challenges to the operating team. We describe here an account of our experiences and a step by step protocol designed by us and followed to troubleshoot the issues encountered. The primary objective of the study was to observe our learning curve in the process of setting up of a new iMRI unit. The secondary objectives were to look at the number of residues detected, quality of imaging, and complications during iMRI. Materials and Methods An observational study was conducted over a 3-month period involving cases requiring iMRI. Initially, a simulation was performed using healthy volunteers, which helped in developing a systematic protocol and drafting checklists to ensure a smooth workflow pattern. Data collection included details regarding hindrances encountered, how these were tackled, iMRI details (residual tumor, re-surgery), and complications, if any. Results A total of 53 cases underwent iMRI in the study period. Among these, 51 were tumor cases that revealed residue (detected in 28 [54.9%] cases), and re-surgery for further resection was performed in 21/28 (75%) cases. A very high level of surgeons’ satisfaction regarding image quality of intraoperative scan was recorded (45/53 [84%]). The number of personnel required for shifting and shifting times could be reduced with efficient utilization of the checklist. Conclusion A methodical approach to tackle impediments while setting up a new unit such as iMRI facilitates its smooth functioning and ensures minimal interruptions and evades undue complications.

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Section: Discussionmentioning

confidence: 99%

Setting Up Workflow of an Intraoperative MRI Unit: A Single-Centre Experience of First 53 Cases

Mohapatra

Balasubramaniam

Rao

et al. 2018

Journal of Neuroanaesthesiology and Critical Care

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“…MR systems are increasingly being installed in environments outside of conventional diagnostic MR facilities. Examples of such facilities include intraoperative/interventional MR, positron emission tomography (PET) MR, and MR‐guided radiation therapy . Each of these facilities present unique challenges to implementing MR safety policies and standard operating procedures, particularly with regard to personnel, screening, site contamination and infection control, and adverse event management.…”

Section: Emerging Areas Of Mr Safety Concernmentioning

confidence: 99%

ACR guidance document on MR safe practices: Updates and critical information 2019

Greenberg¹,

Hoff

Gilk³

et al. 2019

Magnetic Resonance Imaging

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The need for a guidance document on MR safe practices arose from a growing awareness of the MR environment's potential risks and adverse event reports involving patients, equipment, and personnel. Initially published in 2002, the American College of Radiology White Paper on MR Safety established de facto industry standards for safe and responsible practices in clinical and research MR environments. The most recent version addresses new sources of risk of adverse events, increases awareness of dynamic MR environments, and recommends that those responsible for MR medical director safety undergo annual MR safety training. With regular updates to these guidelines, the latest MR safety concerns can be accounted for to ensure a safer MR environment where dangers are minimized. Level of Evidence: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:331–338.

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“…The incidence of complete tumor resection was significantly higher using intraoperative MRI with no increase in neurological deficits compared to conventional surgery ( p = 0.023) ( 13 , 14 ). The intraoperative MRI is inconvenient due to its bulky coil that encroaches on limited surgical space, and its strong magnetic field requires MRI compatible tools and supplies when surgery is performed in the magnetic field ( 15 , 16 ). Although the ioMRI scanner in which the patient is fixed in one position has several advantages (no need to move the patient during the operation, which could lead to potential anesthetic complications, a shorter time to obtain images), it requires non-ferro-magnetic instruments that are not as robust as conventional neurosurgical instruments.…”

Section: Intraoperative Delineation Of Gliomasmentioning

confidence: 99%

The Art of Intraoperative Glioma Identification

et al. 2015

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A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease.

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Intraoperative MRI: Safety

Cited by 25 publications

References 11 publications

Setting Up Workflow of an Intraoperative MRI Unit: A Single-Centre Experience of First 53 Cases

Setting Up Workflow of an Intraoperative MRI Unit: A Single-Centre Experience of First 53 Cases

ACR guidance document on MR safe practices: Updates and critical information 2019

The Art of Intraoperative Glioma Identification

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