On Site CT is Outta Sight
Date: March 1, 2010
This winter, Hopkins became the first of only a handful of U.S. centers to adopt an intraoperative CT that’s so sophisticated it would be at home in a Star Wars movie. Called BrainSuite iCT, it’s the most accurate surgical visualization system available. “In a word, it’s phenomenal,” says neurosurgeon Ali Bydon, who’s had ample time to befriend it.
Newly installed at Johns Hopkins Bayview Medical Center, iCT offers Hopkins neurosurgeons the benefits of versatile, precise, on-site imaging and navigation. Having both available during surgery dispels the traditional cloud of uncertainty that descends when patient anatomy or internal tissue relationships shift during brain or spine surgery.
“An iCT scan before the patient leaves the OR allows you to confirm the adequacy of your job, to see how well nerve roots or the spinal cord are decompressed, for example,” says Bydon, a specialist in spinal reconstruction. The bone-to-tissue contrast is so high that you can easily check that pedicle screw placement is away from nerves, he adds. If a brain tumor’s not removed completely, if clots or small areas of a calcified disc remain, you know it right away.
In short, it shrinks that perennial problem in neurosurgery, having to take patients back to the operating room. “The system reduces the take-back rate almost to zero,” says Bydon. And that obviously lowers infection risk.
Equally impressive is the accurate navigation it brings to surgery. The new software is able to integrate patient brain or spine images taken beforehand by CT, MRI or PET with those made later, during the operation. During surgery, the CT scanner and accompanying touch screen instrument panel—they’re housed in a wall common to two operating rooms—roll out on a floor-based track. Patients stay in situ, not needing to be moved, much less wheeled to a distant imaging suite. The whole process typically takes two minutes.
What’s displayed in the OR— on a wall-mounted screen that’s like a very large iPod where images are whisked open, closed or enlarged with a touch—is a clear, accurate, anatomical roadmap, Bydon says. “The iCT is like the global positioning system in a car. It eliminates the need to stop and ask for directions.”
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