MR-OR helps reduce use of anaesthesia in children at Nottingham

Queen’s Medical Centre (QMC) at Nottingham University Hospitals NHS Trust has acquired a Philips MR-OR intraoperative MRI system. It is being used as a dedicated paediatric MR scanner and, by incorporating Philips’ KittenScanner and Ambient Experience, is helping children undertake MR examinations without general anaesthesia.

MR-OR is an integrated solution for the Philips Elition X 3.0T and delivers quality images during neurological procedures. By integrating a Macquet surgical table with the MR table, the system is transformed into an intra- operative scanner, providing the facility to image patients during neurosurgery. The Elition X offers cutting-edge MR techniques and performs examinations up to 50 per cent faster compared to Philips scans without Compressed SENSE.

The trust undertook a thorough evaluation of MR scanners available for intraoperative imaging, with a focus on the image quality of true intraoperative images acquired using third party frames, as well as image artefacts arising from the surgical cavity and head clamp. The surgical clamps fix on to the table during surgery and aid navigation by linking with Brainlab software, to create a roadmap of the tumour location for the surgeon. The evaluation included visits to several sites across Europe offering high end intraoperative MR (iMR) scanning.

Consultant neurosurgeon and honorary associate professor of neurosurgery Mr Donald Macarthur said: “The clinical impact of the new facility for our service will have two major parts. In the diagnostic pathway, the child-friendly facilities will mean that many of our children won’t need general anaesthesia anymore for their scans. Those who do need it will be managed in spacious and age-appropriate anaesthetic and recovery areas, which will make the experience better for them and their families, and the workflow more efficient for the anaesthetic and radiography teams.

“In our surgical pathway, the iMR theatre is one that has been equipped for both adult and paediatric neurosurgery so we will be using it across the age range; a first for the UK and a strategy that should enable us to quickly gain experience in its use. We anticipate it having an impact in children’s brain tumour surgery, where there is an established track record of achieving more complete resections and reducing the need for second surgeries with iMR, and also for adult pituitary surgery and selected adult brain tumour operations, where completeness of resection is paramount, or surgical visibility is limited, such as in low grade gliomas, pineal and other midline tumours and deep intraventricular tumours.”

Nottingham Hospitals Charity helped fund the equipment. Chief executive Barbara Cathcart said: “We’d like to thank everyone across the local community – from businesses and schools to individuals and families – who helped make this possible by raising money towards our Big iMRI Appeal.”

Picture: MRI modality manager Rodrigo Fabiao, lead MR physicist Dr Paul Morgan, intraoperative MR lead Selene Rowe, MRI radiographer Elsa Goncalves and research MRI radiographer Renata Neves.

Published on the front page of the June 2021 issue of RAD Magazine.

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