Stories From The Theatre: Finding Workflow Harmony

IMRIS Clinical Support
Parker Sims, IMRIS Clinical Applications Specialist

For technology to be effective, it has to be in harmony with the surgeon’s workflow. That’s key to the human experience.

 Parker Sims, an IMRIS clinical applications specialist, takes us into The hybrid IMRIS Surgical Theatre – where his team worked with a leading neurosurgeon to find workflow harmony.

The Challenge

One of the United States’ top pediatric neurosurgeons reached out to us to help him find a more efficient and effective way to complete minimally invasive procedures in his hybrid IMRIS Surgical Theatre. He had performed numerous procedures using innovative surgical modalities such as laser ablation and robotics.

Like most surgeons, his workflow was highly specific. To aid in the placement of laser ablation fibers, the surgeon brought in a new technology, the ROSA® Surgical Robot (a Medtech product), which he had not previously used in his IMRIS Surgical Theatre and was concerned that it could interfere with his workflow.

The Solution

We worked with the surgeon and his staff from the very beginning. We involved everyone at key milestones, making sure every decision – from workflow specifics to the technology itself – made sense with the end goal being his surgical case.

When the date of the scheduled case arrived, he was already comfortable with the case workflow that we helped him establish. That service was carried out as part of IMRIS’ Premium Clinical Support model, which enables us to work with surgeons and OR staff before, during, and after the case to migrate workflow, train clinical staff, and consult during procedures – to help bring everything together for the best and safest possible outcome for the patient.

We adapted the environment to the surgeon’s needs, rather than the other way around. This is key when you’re introducing disruptive innovation to the OR.

– Parker Sims, IMRIS Clinical Applications Specialist


Stories From the Theatre: A Tall Order

IMRIS Program Manager, Rick Dolan, takes us through a unique challenge our team encountered while they were installing an IMRIS Surgical Theatre in Beijing, China.

THE CHALLENGE.

How do you get an 8-ton magnet, along with the steel infrastructure to support it, into the upper floor of a hospital?

We recently constructed an IMRIS Surgical Theatre at Tiantan Hospital in Beijing. It included the ‘movable’ iMRI system, one of IMRIS’ core innovations, and installing it required some creative solutions. Fortunately, that’s where we excel.

 

THE SOLUTION.

Working closely with the hospital staff, we temporarily removed some of the building’s large windows, and then used a series of cranes to carefully lift the infrastructural components into the Theatre space.

Installing a surgical theatre is a logistical challenge like no other… especially when you’re working with innovative technology, things that have no precedent. You can’t treat it like a traditional construction project, because there’s nothing traditional about it. You have to have a Program Manager maintaining constant contact with all the stakeholders, especially hospital staff, through every stage of the process. It’s not enough to control what’s happening in your area of construction; the hospital is very active around you, and you have to be mindful of those variables and prepared to adapt.

“With comprehensive program management and a solid line of communication, IMRIS is uniquely equipped to tackle the many challenges that emerge during the ‘Creation’ process.”

– Rick Dolan, IMRIS Program Manager

 


IMRIS Reports Continued Strong Growth in 2017

Milestones include 67 percent new system growth, launch of a new brand, new personnel and strong financial earnings success

MINNETONKA, MINN. (Feb. 8, 2018) – IMRIS, the global leader in intraoperative imaging, reported significant business growth in 2017, including milestones in financial earnings, new system bookings, and personnel. Strong business management and consistent execution has resulted in two consecutive years of steady growth. IMRIS’ strong financial performance was driven by 67 percent growth in system bookings – a result of winning multi-million dollar contracts with top-tier hospitals around the world. Due to continued business growth, IMRIS has expanded the organization incrementally with the addition of more than 25 new personnel in the past 12 months.

“In 2017, IMRIS focused on adding new talent, organizing the company for continued growth, and completing a major rebrand aligned with our core values,” says IMRIS President and CEO Andrew Flanagan. “This year, we’re looking forward to building on that momentum with new product launches, growth in research and development spending combined with expanded clinical services that will demonstrate IMRIS’ commitment to innovation via product and clinical solutions.”

In September 2017, the company celebrated its two-year anniversary under new ownership – a major milestone substantiated by strong financials. It was at this time that IMRIS unveiled its new brand which reflects the way that they will continue to deliver on their promise to neurosurgeons, patients and customers. Product milestones in 2017 included a completed device listing and registration with the U.S. Food and Drug Administration (FDA) for a new multi-functional operating room table specifically designed for the IMRIS Surgical Theatre that will provide significant workflow improvements to support better patient outcomes.

The company’s flagship IMRIS Surgical Theatre features the world’s only moving ceiling-mounted intraoperative magnetic resonance imaging (iMRI) or computed tomography (iCT) imaging modality, allowing neurosurgeons to see critical anatomical detail while the patient is on the operating table. The IMRIS solution gives surgeons a way to bring advanced imaging technology to the patient rather than moving the patient in and out of the operating room. The results are life-changing for patients – providing neurosurgeons greater precision and accuracy during surgery, reducing the need for additional operations, and reducing the possibility of complications associated with moving the patient.

Increasing numbers of hospitals are now considering the IMRIS Surgical Theatre as the standard of intraoperative care, resulting from the increased efficiency and accuracy it brings to neurosurgeons, as well as improvements in patient outcomes. In the past two years, IMRIS has expanded its customer base to more than 75 customers worldwide in some of the most prestigious hospitals globally including Brigham and Women’s Hospital, Massachusetts General Hospital, Cleveland Clinic, Johns Hopkins Hospital and Beijing Tiantan Hospital. To date, more than 30,000 patient lives have been impacted by the IMRIS Surgical Theatre.

“With tens of thousands of lives impacted thus far, the IMRIS team looks forward to another year of expanded innovation that will bring advanced imaging technology and new data solutions that will transform the way patients receive treatment and hospitals administer care. Our goal is to elevate both the medical experience and the human experience,” says Flanagan.

 

ABOUT IMRIS

As a leader in image guided therapy solutions, IMRIS offers the most advanced hybrid surgical theatres with the world’s first and only moving ceiling-mounted iMRI and iCT technology that gives neurosurgeons access to high-quality image detail pre-, mid- and post-operation. With a unique symphony of engineering and advanced imaging technology, the IMRIS Surgical Theatre is built for the human experience and inspired by the human mind. IMRIS serves leading hospitals worldwide, offering optimized workflow for surgeons, maximum value for hospitals and better outcomes for patients. As part of its four-pronged business model – Consult, Design, Create and Support – each IMRIS Surgical Theatre is custom-developed for the hospital and surgeons to uniquely compliment their workflow and intended use. For more information, call 763.203.6300, email info@imris.com or visit www.imris.com.

 


The Industry’s Most Comprehensive ‘Creation’ Experience.

 

We’ve streamlined the construction experience – consolidating everything from rigging and installation to program management.

With comprehensive program management, we handle the countless variables that emerge when installing high-tech equipment into a medical environment.

We support the general contractor, minimizing errors. We stay in close contact with the hospital, reducing interruption. As we configure technologies according to your site’s design, we provide the level of precision our stakeholders expect.

 

TIMELINE: FROM INITIAL PLANNING TO FINAL COMMENCEMENT.

PHASE I: PLANNING

  1. Project launch
  2. Technical requirement drawings
  3. Final structural review
  4. Infrastructure drawings
  5. Final architectural design, review and sign-off

PHASE II: EXECUTION

  1. Demolition and/or structural modification
  2. System installation

PHASE III: COMMISSIONING

  1. System testing
  2. Training
  3. Handover

Stories From the Theatre: A Seismic Challenge

 

For the first time in history, a movable iMRI with an ‘integrated seismic system’ has been successfully implemented.

IMRIS Senior Technical Specialist, Jorge Kern, takes us through the seismic challenge, the creative solution, and the revolutionary innovation that’s bringing intraoperative imaging to places it’s never been.

 

A CHALLENGE BENEATH THE SURFACE.

 

Like many of the world’s leading neurological institutions, The University of Tsukuba Hospital was ready to invest in intraoperative imaging – a technology that enables surgeons to obtain real-time, diagnostic-quality images during operations. For neurosurgeons, introducing this innovation would mean better resection-rates. For patients, it would mean better outcomes. For the University of Tsukuba Hospital, it would mean a new level of institutional prestige.

However, just beneath the surface of the promising opportunity, there was a challenge.

Each year, Japan experiences more than 1,500 earthquakes. That kind of frequent seismic activity can be detrimental to intraoperative imaging: in terms of image-quality, reliability and safety. For the University of Tsukuba Hospital, those factors made intraoperative imaging immensely challenging.

It was up to our team of designers, architects, engineers and clinical specialists to find a solution.

 

CRAFTING AN INNOVATIVE SOLUTION.

To bring intraoperative imaging to the University of Tsukuba Hospital, we had to accomplish 3 things, despite being in a seismic event-prone region:

  1. Performance. The slightest vibration can lead to ‘motion artifacts’ in MR images, rendering them unusable for diagnostics. To meet the strict Vibration Isolation Requirement of MRI technology, we engineered a device that, when triggered by a certain amount of vibration, causes MR imaging to stop when image quality is compromised.
  2. Safety. There are strict regulations for medical technology in earthquake-prone regions. We engineered a solution to meet those regulations – protecting patients and clinical staff – while functioning with existing technology and workflows. The seismic foot, for example, is a device designed to prevent the magnet from disengaging from the rails during an earthquake.
  3. Reliability. We developed what we call a ‘passive solution’, rather than ‘active’. It couldn’t be a sensor that is affected by seismic activity because the sensor could potentially fail. The solution had to be something ingrained in the structure itself that would stop the magnet if an earthquake occurred.

 

 

The ‘seismic stabilizer system’ we created is the first of its kind.

It consists of a stabilizer pad, a bolt-on accessory mounted directly under the magnet. During the operation, as the iMRI travels into the IMRIS Surgical Theatre, the pad is elevated about 25 mm above the ground. Then, when it’s time for imaging, the pad lowers to the floor. The hanging rails support the actual weight of the magnet, while the stabilizer prevents it from swinging side-to-side during seismic activity.

That means guaranteed performance, safety, and stability. 

 

 

Next, it was time to put our innovation to the test.

We brought the seismic stabilizer system to the University of Buffalo’s Structural Engineering and Earthquake Simulation Laboratory, where it underwent rigorous testing on a ‘shaker table’. By simulating the conditions of a powerful earthquake, we ensured the device would function as predicted.

Now, it was time to introduce it to the real world.

 

ELEVATING THE HUMAN EXPERIENCE.

 

Since the installation, the seismic stabilizer system has been an overwhelming success.

Ninety-one patients have undergone neurosurgical intervention using the University of Tsukuba Hospital’s IMRIS Surgical Theatre. During that time, there have been 169 seismic events in the area, and the system continues to function as it was designed.

 

 IMPACTING GLOBAL HEALTHCARE.

 

The seismic stabilizer system is a tremendous achievement for the University of Tsukuba Hospital.

But it’s also an achievement for patients, surgeons and institutions around the world.

Right now, hospitals everywhere are demanding the intraoperative imaging capabilities of the IMRIS Surgical Theatre, and some of them are located in seismic event-prone regions like Japan and California. Now, with this new technology, we can bring better outcomes to their institution – wherever they are. 

– Jorge Kern, IMRIS Senior Technical Specialist

 


Designed to Move.

IMRIS Ceiling Mounted Moveable MRI

 

AS INTRAOPERATIVE IMAGING GOES MOVEABLE, DESIGN MUST MOVE WITH IT.

For emerging technology to be truly effective in a surgical environment, it must fit naturally into the surgeon’s existing workflow. Innovation must integrate, rather than interrupt – an objective that moves us to expand the definition and the magnitude of intraoperative Design.

Intraoperative imaging allows surgeons to obtain diagnostic-quality images of the patient during surgeries – giving the clinical team a new layer of information, insight that empowers them to make more intelligent decisions and increase the likelihood of a positive outcome. Moveable intraoperative scanners take it to the next level. By keeping the patient stationary and bringing the scanner to them, these devices significantly lower the risk of trauma and infection.

And while intraoperative imaging is an unprecedented opportunity for surgeons, patients and hospitals alike, it also presents an unprecedented challenge:

A challenge that calls for the evolution of intraoperative Design.

 

Diagram of rail system

 

»  SAFETY BECOMES AN ELEMENT OF DESIGN.

Safety always means proper training for clinical teams, but with a powerful magnet moving in and out of the OR, it becomes an element of Design. In addition to a comprehensive network of safety interlocks and collision-detection systems, our planners concentrate on the positioning of equipment – especially those with magnetic properties affected by the magnetic field – along with visual cues (such as the Gauss Line) making it easier for the clinical team to position technology outside the magnetic field.

 

»  OPTIMIZING THE SURGICAL ENVIRONMENT BECOMES MORE IMPORTANT AND MORE COMPLEX.

Quality is critical to the efficacy of intraoperative imaging. To enable diagnostic-quality imaging in the OR, our planners craft a stable environment by considering factors such as:

o   Equipment vibration and magnet stability

o   Location of power supply-lines

o   Magnetic shielding requirements

o   Magnetic effects of ferrous metal masses

 

»  THE RIGHT ACCESSORIES BECOME CRITICAL

Accessories are always important to a surgeon’s workflow. However, when moveable intraoperative imaging is introduced to the OR, our planners consider accessories that can aid both intraoperative transitions and function with the scanner present – including MR-friendly head-fixation devices, adjustable boom-lighting and LCD monitors, and even the new IMRIS MR NEUROSURGICAL TABLE, which enables clinical teams to achieve optimal patient-positioning for scanning.

 

»  THE SURGEON BECOMES A ‘DESIGNER’.

When designing an IMRIS Surgical Theatre, the surgeon should always be involved in the process; but when the Theatre incorporates intraoperative imaging, it’s the only way for the Design to be a success. We engage the surgeon at the very beginning of the process, familiarizing ourselves with the subtle nuances of their workflow. When it’s time to design the Theatre, we use this relationship to inform every decision – from the positioning of equipment to the architecture of the Theatre itself.

 

»  THE INTRAOPERATIVE TRANSITION EVOLVES INTO A FORM OF ART.

At some point during a surgery, the surgical team may decide to take a scan of the patient – requiring them to transition the OR into an imaging-ready environment. Planners play a critical role in making this an intuitive, streamlined process. They plan for the space to position the equipment outside the magnetic field. Timing is critical to the success of the operation, so our planners consider implementing elements that streamline the transition, such as distinct electrical systems, which allow the clinical team to shut-off only the equipment that emits radio frequency that affects image quality, while also keeping critical care equipment powered.

 

»  DESIGN MOVES AWAY FROM A FINITE SERVICE.

The Design team should be involved in every stage of the process – from initial consultation to creation and ongoing support – constantly leveraging their intimate knowledge of the clinical team’s workflow to craft the right Design for the specific situation.

To create an effective moveable intraoperative imaging solution, Design becomes a fluid element of the greater process and is no longer a finite service.


Pioneers of Intraoperative Design.

IMRIS Surgical Theatre

 

WORKFLOW-SPECIFIC, VALUE-FOCUSED, OUTCOME-DRIVEN DESIGN. 

By adapting and integrating intraoperative innovations into specific workflows, we elevate not only the medical experience, but the #HumanExperience.

To meet this challenge, IMRIS has pioneered a new approach to Design.

 

 

TAILORED TO THE SURGEON’S WORKFLOW. 

 

Surgeon workflow drawing

 

A surgeon’s workflow is as unique as the surgeon. When designing an IMRIS Surgical Theatre, our team of architects and planners leverage an intimate understanding of the surgeon’s specific workflow to inform every element of Design.

 

  • Maintaining diagnostic-quality images. For intraoperative imaging to be effective, it must provide the clinical team with diagnostic-quality imaging during surgery. To make that possible, the entire IMRIS Surgical Theatre must be optimized for imaging. At IMRIS, our architects and planners consider everything from vibration and sound transmittance to External Field Interference (EFI) for multi-imaging positions.

 

  • Designing for a comprehensive system. IMRIS Surgical Theatres do not exist in a silo. Operating rooms (ORs) and other departments are often positioned directly above, below, and adjacent to the Theatre. Since intraoperative imaging involves a high-powered moving magnet, IMRIS Theatres are designed to prevent interference with neighboring areas – while optimizing patient-flow.

 

  • Mastering the transition. When it’s time for the patient to be scanned, the OR must be transitioned into an MR-safe environment. To make this process quick, efficient and safe, our architects and planners take into account various elements such as distinct electrical systems, equipment positioning, and effective, intuitive safety protocols.

 

  • Aggregating the right technology. Our Design team works closely with hospital architects, consultants, and leading technology providers to bring together the right technology for the unique surgical environment. For example, when designing an IMRIS Surgical Theatre with a moveable intraoperative MRI, we consider incorporating the IMRIS MR Neurosurgical Table, created in collaboration with Trumpf Medical. The distinct tabletop was designed by IMRIS for intraoperative imaging, and enables clinical teams to position the patient at the optimal angle for imaging access.

 

  • Providing long-term clinical and technical support. We provide clinical support and 24/7 technical service for the life of an IMRIS Surgical Theatre. We have a dedicated team of clinical specialists who work with hospital architects to optimize the surgeon’s workflow. Our architects and planners ensure the final architectural layout incorporates the surgeon’s workflow preferences and is within the Theatre’s capabilities. Our team of customer service engineers provide technical support after the Theatre is installed.

 

FOCUSED ON THE HOSPITAL’S VALUE.

 

IMRIS iMRI ceiling-mounted rail

 

Intraoperative imaging is a major investment. As we integrate these systems, our Design team considers not only how these technologies can benefit the surgical team, but how they can maximize the hospital’s return-on-investment (ROI).

 

  • Fostering interdepartmental collaboration. Design is critical to discovering creative solutions that maximize ROI. When designing an IMRIS Surgical Theatre, we always consider how certain elements can benefit other departments. For example, when properly positioned within the hospital and the Theatre itself, radiology can use the intraoperative scanner for diagnostics (when not in use by the surgical team).

 

  • Providing a comprehensive solution. To create a groundbreaking IMRIS Surgical Theatre, it is essential to bring together the right technology providers. It can be an expensive, time-consuming administrative challenge that drains ROI. We’ve designed an alternative. At IMRIS, we provide a comprehensive solution – leveraging industry partnerships and incorporating Design into a complete process, a holistic solution that begins with initial consultation and carries through long-term support.

 

  •  Designing for the future. When we design an IMRIS Surgical Theatre, our team focuses on not only maximizing the hospital’s value for today, but also preparing for the challenges and opportunities of tomorrow. This proactive approach reduces future expenses and allows for continued evolution.

 

DRIVEN TO IMPROVE PATIENT OUTCOMES.

 

Grandfather and grandson in IMRIS Surgical Theatre

 

Intraoperative imaging is producing better outcomes around the world – allowing clinicians to perform new, minimally invasive procedures and reducing the likelihood of follow-up surgeries.

Our architects and planners can help push this innovation further. Using our unique, ceiling-mounted rail system we’ve designed an intraoperative MRI scanner that moves to the patient, rather than the other way around. Scans can be taken without moving the patient from the surgical position, significantly reducing the risk of potential trauma and infection.


IMRIS and Hill-Rom Announce FDA Clearance of New MRI-Conditional Surgical Table For Hybrid OR


The multi-functional, MRI-conditional table is designed for complex neurosurgery and enhanced intraoperative scanning workflow; accommodates multiple specialties with a range of tabletops

CHICAGO – RSNA 2017 (November 27, 2017) – IMRIS and Hill-Rom (NYSE: HRC) announced that Hill-Rom’s Trumpf Medical has completed device listing and registration with the U.S. Food and Drug Administration (FDA) for a new multi-functional operating room table specifically designed for the IMRIS Surgical Theatre. This innovative joint development integrates a new IMRIS MR Neuro tabletop and Hill-Rom’s TruSystem® 7500 Surgical Table platform with the IMRIS Surgical Theatre to support better patient treatment.

The new surgical table system will be an essential component of the IMRIS Surgical Theatre – a suite of intraoperative imaging technologies that allow neurosurgeons to see critical anatomical detail during surgery, without moving the patient from the operating table.

The new TruSystem™ 7500 MR Neuro Surgical Table is specifically engineered for the MRI environment, integrates with the IMRIS Head Fixation portfolio, and is segmented for optimal patient positioning. Furthermore, the multi-functional design offers the flexibility of interchangeable tops and therefore multi-disciplinary use.

“Our customers challenged us to develop a premium surgical table to be a key component of the IMRIS Surgical Theatre with the reliability and flexibility to meet the needs of current and future surgical applications,” said IMRIS President and CEO Andrew Flanagan. “Our partnership with Hill-Rom Surgical Solutions leverages the reliability and advanced features of the TruSystem® Surgical Table platform together with the MR Neuro tabletop and head fixation system. This new offering will become a key part of our mission to optimize the surgical workflow.”

The IMRIS Surgical Theatre features the world’s only moving ceiling-mounted iMRI and iCT solution that delivers advanced imaging in the surgical environment. The images give neurosurgeons greater precision, improve patient outcomes and eliminate the risks inherent in moving a patient during a procedure.

Hill-Rom is a global leader in developing innovative technology for operating rooms and intensive care units. Rapid, smooth workflows are of life-saving importance, and its digital systems and automated intelligence solutions are becoming a standard of care in hospitals worldwide.

“We’re thrilled to partner with IMRIS, to offer enhanced flexibility and efficiency for surgeons with the integration of the IMRIS Surgical Theatre and the TruSystem® 7500 MR Neuro Surgical Table,” said Francisco Canal Vega, president of Hill-Rom Surgical Solutions. “Our proven reliability, ergonomic design and range of options will prove to be a valuable addition to the IMRIS portfolio, meeting the demands of the neurosurgeon and the expectations of hospital administration.”

The new surgical table will be part of a limited market evaluation to understand how this new system can be best utilized to elevate the intraoperative experience. Full market launch is expected in early 2018.

About IMRIS

As a leader in image guided therapy solutions, IMRIS offers the most advanced hybrid surgical theatres with the world’s first and only moving ceiling-mounted iMRI and iCT technology that gives neurosurgeons access to high-quality image detail pre-, mid- and post-operation. With a unique symphony of engineering and advanced imaging technology, the IMRIS Surgical Theatre is built for the human experience and inspired by the human mind. IMRIS serves leading hospitals worldwide, offering optimized workflow for surgeons, maximum value for hospitals and better outcomes for patients. As part of its four-pronged business model – Consult, Design, Create and Support – each IMRIS Surgical Theatre is custom-developed for the hospital and surgeons to uniquely compliment their workflow and intended use. For more information, call 763.203.6300, email info@imris.com or visit www.imris.com.

About Hill-Rom Holdings, Inc.

Hill-Rom is a leading global medical technology company with more than 10,000 employees worldwide. We partner with health care providers in more than 100 countries, across all care settings, by focusing on patient care solutions that improve clinical and economic outcomes in five core areas: Advancing Mobility, Wound Care and Prevention, Patient Monitoring and Diagnostics, Surgical Safety and Efficiency and Respiratory Health. Hill-Rom’s people, products and programs work towards one mission: Every day, around the world, we enhance outcomes for patients and their caregivers. Visit www.hill-rom.com for more information.

TruSystem is a registered trademark of Trumpf GmbH + Co. KG.

©2017 Hill-Rom Services, Inc. ALL RIGHTS RESERVED.