The Advanced Multimodal Image-Guided Operating (AMIGO) suites (a set of 3 rooms) was conceived, designed, and implemented through the vision of Drs. Ferenc Jolesz and Clare Tempany. It is co-funded by NIH grants and the Brigham and Women's Hospital (BWH) in Boston. It covers a 5,700 square foot area divided into three sterile procedure (MRI, Operating, PET/CT) rooms in which multidisciplinary teams treat patients using multiple imaging modalities.
This room houses an IMRIS system comprised of a high-field (3 Tesla) wide-bore (70 cm) Siemens Verio MRI scanner integrated with full OR-grade medical gases, MRI-compatible anesthesia delivery and monitoring system, and therapy delivery equipment. The MR scanner is mounted on the ceiling and can traverse on ceiling rails to a fully draped patient on the OR table, a typical scenario for brain tumor surgery. The MR room design is such that it can be used independently for MR-interventional radiology procedures such as prostate biopsy and focal ablation therapy. There are now 57 IMRIS installations worldwide and 82 ORs using this intra-operative MRI technology, mostly for neurosurgical applications.
The center room of the AMIGO is a hybrid operating room (OR), flanked by the adjoining MRI and PET/CT rooms. The room is equipped with MRI-compatible anesthesia delivery and monitoring systems, a surgical microscope with near-infrared capability, surgical navigation systems that track handheld tools, probes, a ceiling-mounted single plane angiographic x-ray system, and 2D and 3D ultrasound imagers. Brain tumor surgery and lung wedge resection surgery take place in this room, with the use of ceiling mounted MRI and angiographic imaging, respectively.
One of the most innovative features of the AMIGO is the inclusion of PET in the surgical environment. The AMIGO Suite has been the first in the world to use PET/CT and MRI in an operating room environment for image guided therapy applications. The PET/CT imaging enables the use of molecular imaging intraoperatively for guiding not only biopsies but also surgical interventions. There is a transfer table for moving patients between the PET/CT table for imaging and the OR table for surgery.
The overall goal of AMIGO has been to provide a test-bed with different imaging modalities to evaluate the utility of pre-procedural or intraprocedural imaging during surgery and interventions to enable precise definition of the tumor to ensure complete resection or in situ destruction. Once the safety and feasibility of integrating the imaging modality with the surgical procedure has been evaluated and all the applied methods are validated, the procedures will be transferred to dedicated IGT suites that may not have all the features of AMIGO, but only those that are necessary to the procedure. The multidisciplinary nature of the program is reflected in the distribution of the projects between surgery, radiology and radiation therapy.