From the April 2019 issue of HealthCare Business News magazine


It’s completely different when performing glioma resection because there we are just giving advice about the degree of resection and we are not in the OR during surgery. But in general, it has been an opportunity for us to work closer together rather than be divisive.

HCB News: Does Mayo continue to find new applications for intraoperative MR? If so, can you tell us some of the latest ways it's being utilized?
JH: When we built this space, we did so in anticipation of MR-guided focused ultrasound. We built an adjacent room so that we could put in a focused ultrasound unit, which is now up and running.
We are finding it to be extremely helpful. We are now only doing the standard clinical work. It has been shown that you can open the blood-brain barrier with focused ultrasound to treat gliomas. We are not doing that yet, but we are beginning the research in this area.

In addition, we are currently opening a hybrid three-room image-guided therapy suite to expand our body MR-guided work. This includes MR in the center room, which has been up and running for about a year and a half. On either side of the MR is an interventional CT procedure room.

Sometimes it’s easier to place a probe under CT guidance but once you are treating, MR has the advantage of watching the thermal change of the tissue. If you know that you’ve created a certain temperature and a certain volume, then you know your treatment has been successful.

Our body radiologists are using MR guidance for cryoablation, ablation, and focused ultrasound treatment of prostate cancer. It’s also being used for other applications, including lesioning of liver tumors.

HCB News: Have software upgrades played a role in the expanded capabilities of intraoperative MR?
JH: Vendors are developing better-integrated image management and guidance techniques leading to improved and advanced MR-guided procedures. As images from different modalities are able to be merged, such as ultrasound and CT with MR, better lesion localization and treatment monitoring are possible.

HCB News: In what ways do you imagine image-guided procedures being more advanced in five or 10 years?
JH: I think that image-guided procedures will only continue to increase in complexity and volume. There are many opportunities for providing these services and advancing them. There is no question that a holdup is the technology that is required, but with scale and improvements one can envision this having an increasing impact in health care.

For instance, if you have an essential tremor you have the opportunity to undergo deep brain stimulation. We know that it is effective. However, what about the opportunity to spend three hours in an MR magnet and have a potentially similar outcome without the need to perform the open surgery or purchase the deep brain stimulating hardware?

But there are obstacles. For instance, focused ultrasound is an effective way to treat uterine fibroids, however, because of limited reimbursement it is not widely available. If medicine changes from fee-for-service to a more population-based, managed environment, then we could well migrate to those treatments that are less costly such as image-guided and MR-guided procedures.

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