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New operating room a high-tech wonder

At Brigham and Women’s, imaging devices close at hand to surgeons seeking real-time data

SURGICAL THEATER: The equipment pulls together all the imaging technologies in real-time information for clinicians and surgeons.Suzanne Kreiter/Globe Staff

Even the patients are amazed.

Facing a procedure for cervical cancer, Samantha Zediker was wheeled into Brigham and Women’s Hospital’s new $20 million operating room last month. She was so awed by what she saw, she almost forgot to be nervous. “It was overwhelming,’’ she said. “Honestly, it was sort of cool. There were all these machines and lights and equipment.’’

After nearly two decades of planning, Brigham and Women’s has opened the first surgical facility of its kind in the United States, a cavernous, three-room operating suite that is packed with gleaming, high-tech medical imaging technology - from MRI systems to the latest ultrasound machines - and is designed to allow surgeons to use just the right equipment to aid a wide variety of procedures and treatments.


Named AMIGO - an acronym for advanced multimodality image-guidance operating - the facility is also a research station, where the hospital and the National Institutes of Health, which contributed millions to fund its construction, will investigate what systems work best with different surgeries. The goals: to transform surgical techniques, improve patient care, and reduce the costs of expensive operating-room procedures.

The NIH provided $5 million for building AMIGO and several million dollars more for planning, while Brigham and industrial partners invested about $15 million in the suite.

The concept is deceptively simple: Combine the most advanced imaging systems in one suite, rather than scattered around the hospital. Each imaging technology has different capabilities. Doctors performing procedures can watch real-time images of the body and help determine which technology works best for, say, an operation for a brain tumor, or the treatment of cardiovascular problems.

Such image-guided surgeries are common; magnetic resonance imaging devices, for instance, have long been used by doctors to help view internal areas of the body while performing complicated surgeries. But never before have all the most advanced imaging devices been available in one operating room - or in the case of Brigham and Women’s, within a custom-built, 5,700-square-foot suite with unfolding walls.


It has it all: an MRI device that can be rolled into the operating room via a ceiling-mounted rail system; a positron emission tomography-computed tomography (PET/CT) machine to reveal biochemical or metabolic activity; an angiography X-ray machine to view arteries and veins; an X-ray fluoroscopy machine that uses dyes to show blockages; and an ultrasound system for tumor identification and targeting.

All the devices are integrated through an electronic system made by Winnipeg-based IMRIS Inc., which pulls together many of the imaging technologies for viewing within the central operating room.

“Having all these devices together is absolutely unique,’’ said Dr. Steven Seltzer, chairman of Brigham and Women’s radiology department. “AMIGO is like an operating room on steroids.’’

For Dr. Ferenc Jolesz, co-director of the hospital’s AMIGO program, the new operating suite is almost like the Holy Grail of image-guided surgery. “Everybody has these imaging devices, but they’re not all together,’’ said Jolesz. “When doing surgeries, you need fresh images in real time, not just before or after surgeries,’’ because body organs and tissues can subtly shift position after diagnostic images are taken, making pre-operation images potentially outdated by the time a surgeon lifts a scalpel.

Sometimes, surgeons simply cannot see details such as malignant tumors well enough with the naked eye, and need real-time images on display during operations, noted Jolesz.


Since becoming operational a few months ago, the AMIGO suite has been used for about 30 operations. Clinicians have performed brain, prostate, and other soft-tissue biopsies; prostate and cervical cancer therapies; and various brain tumor procedures.

Zediker, for example, had two internal radiation treatments last month in the new AMIGO suite. Diagnosed more than a year ago with cervical cancer, she had had limited surgery and other treatments. Doctors later found a recurrent tumor, prompting a combination of new radiation and chemotherapy treatments.

The imaging available in AMIGO allowed her surgeon, the Brigham’s director of gynecologic radiation oncology, Dr. Akila Viswanathan, to better pinpoint the tumor, and gave medical personnel the ability to more precisely implant a radiation dose directly into the tumor, according to Brigham.

“So far, so good,’’ Zediker said last week.

Both Brigham and Women’s and the NIH stress that AMIGO is still within the study stage. To date, each patient who has been cared for in the facility has been enrolled in a research program that includes collection of data related to imaging use, surgical protocol, and patient outcomes.

“One has to look at it as a research lab,’’ said Abraham Levy, program director of the NIH’s National Center for Research Resources. “I cannot tell you, ‘Here is the end product we’re looking for.’ It’s a research program, and the progress will be very slow.’’

Officially designated by the NIH in 2005 as the country’s national center for image-guided therapy, Brigham and Women’s will distribute research data and information to other institutions for review and possible adoption.


But not every hospital will end up with a full-fledged AMIGO suite, Levy cautioned.

“The suite is extremely expensive, and it can’t be used by everyone,’’ he said. “The hope is to develop pioneering new procedures for use by others.’’

David Graves, chief executive of IMRIS, said the company has been involved in the construction of scores of new operating-room systems, but never on the scale and complexity of the AMIGO suite.

“The system at the Brigham is unbelievable,’’ said Graves. “The benefits to patients will be huge.’’