What is Intraoperative Magnetic Resonance Imaging (iMRI): Purpose, Procedure, Results & Costs in India

In the intricate world of modern medicine, precision is paramount, especially when it comes to delicate surgical procedures within the human body. Neurosurgery, dealing with the brain and spinal cord, exemplifies this need for absolute accuracy. Enter Intraoperative Magnetic Resonance Imaging (iMRI) – a groundbreaking technology that is revolutionizing how surgeons navigate the most complex landscapes of the human anatomy. Ayu, your trusted partner in managing medical records, brings you a comprehensive guide to understanding iMRI, its profound impact, and its relevance in the Indian healthcare landscape.

What is Intraoperative Magnetic Resonance Imaging (iMRI)?

Intraoperative Magnetic Resonance Imaging (iMRI) is a state-of-the-art medical imaging technique that integrates an MRI scanner directly into the operating room environment. Unlike conventional MRI scans performed before or after surgery, iMRI provides real-time, high-resolution images of a patient's internal structures during the surgical procedure itself. This cutting-edge technology is primarily utilized in neurosurgery, but its applications are expanding, aiming to elevate surgical precision and significantly improve patient outcomes, particularly in challenging cases like brain tumor resections.

The core essence of iMRI lies in its ability to offer an immediate and accurate visual update of the surgical site while the operation is in progress. This is especially critical in neurosurgery due to a phenomenon known as "brain shift." After a craniotomy (opening the skull) or the release of cerebrospinal fluid, the brain's position can subtly change. This shift means that pre-operative MRI images, no matter how detailed, might no longer perfectly reflect the brain's exact anatomical configuration during the surgery. This discrepancy can lead to inaccuracies in surgical navigation and potentially impact the completeness of tumor removal or the avoidance of critical brain regions.

An iMRI system effectively turns the operating room into a "Brain Suite," a specialized environment where the surgical team can pause the procedure, perform an MRI scan, review the fresh images, and then resume surgery with updated, precise information. This continuous feedback loop empowers surgeons with unparalleled guidance, allowing for dynamic adjustments and informed decision-making at every critical juncture of the operation. The high-resolution images generated by iMRI enable surgeons to clearly distinguish between healthy tissue and abnormal structures, identify the precise margins of a tumor, and confirm the extent of removal before the patient even leaves the operating theatre. This level of immediate validation is a game-changer, promising safer surgeries, more complete resections, and ultimately, better quality of life for patients.

Why is Intraoperative Magnetic Resonance Imaging (iMRI) Performed?

The primary purpose of iMRI is to overcome the limitations of pre-operative imaging and provide surgeons with an unprecedented level of real-time insight into the surgical field. This translates into numerous critical benefits, making iMRI an invaluable tool for complex neurosurgical interventions.

Here’s why iMRI is performed:

• Accurately Identify Brain Abnormalities: In brain surgery, differentiating between the tumor and surrounding healthy brain tissue is often a significant challenge. Tumor margins can be subtle, diffuse, or blend with normal brain structures. iMRI provides precise, updated images that help surgeons pinpoint the exact location of lesions and clearly distinguish tumor boundaries from vital healthy tissue. This detailed visualization is crucial for aggressive yet safe tumor removal.

• Achieve More Complete Tumor Removal (Extent of Resection - EOR): One of the most significant advantages of iMRI is its ability to facilitate a more complete resection of tumors. By allowing surgeons to scan mid-procedure, they can detect any residual tumor tissue that might have been missed or obscured by brain shift. This immediate feedback enables them to continue operating until the maximal safe resection is achieved. A more complete removal significantly reduces the likelihood of tumor recurrence and the potential need for follow-up surgeries or additional aggressive treatments, improving long-term prognosis for patients.

• Minimize Neurological Injury: The brain is a complex organ where different regions control vital functions. Damaging critical areas during surgery can lead to severe neurological deficits. iMRI’s real-time guidance acts as a continuous navigational map, helping surgeons meticulously avoid eloquent (functionally important) areas of the brain. By providing an updated view of the brain's anatomy and the tumor's relationship to critical structures, iMRI significantly reduces the risk of inadvertently damaging vital nerves or functional brain regions, thereby preserving neurological function and enhancing post-operative quality of life.

• Confirm Successful Removal: Traditionally, surgeons rely on their visual assessment and pre-operative images during surgery. With iMRI, they can perform a final scan before closing the surgical site to confirm the extent of tumor removal. This immediate validation ensures that the surgical goals have been met, providing peace of mind for both the surgical team and the patient, knowing that the most complete removal possible has been achieved in a single sitting.

• Reduce Complications and Recovery Time: By enabling a more precise and complete surgery in a single sitting, iMRI can lead to fewer complications post-operatively. The reduced need for re-operations due to incomplete resection, coupled with minimized neurological injury, often translates to a smoother recovery period for the patient. A more effective initial surgery can potentially shorten hospital stays and accelerate the return to normal activities.

Beyond brain tumors, iMRI's precision-enhancing capabilities extend to a wide range of neurosurgical applications:

• Pediatric Brain Tumors: Offers enhanced precision in delicate surgeries on young patients.
• Epilepsy: Helps in precisely locating and resecting the epileptogenic zone (the area of the brain causing seizures).
• Dystonia and Essential Tremor: Used for precise targeting in Deep Brain Stimulation (DBS) procedures, where electrodes are implanted in specific brain regions.
• Glioma: Facilitates maximal safe resection, crucial for these aggressive brain tumors.
• Parkinson's Disease: Aids in accurate placement of DBS electrodes, improving motor symptoms.
• Neuropsychiatric Disorders: Used in select cases for precise lesioning or DBS placement.
• Pituitary Tumors: Enhances the completeness of removal, especially for tumors close to critical structures like the optic nerves.

In each of these applications, iMRI's ability to provide immediate, updated anatomical information empowers surgeons to perform with greater confidence and accuracy, ultimately aiming for the best possible functional outcomes for their patients.

Preparation for Intraoperative Magnetic Resonance Imaging (iMRI)

Preparing for an iMRI procedure involves a combination of standard surgical preparation guidelines and specific precautions related to MRI scanning. For Indian patients, as with any advanced medical procedure, thorough preparation and clear communication with the healthcare team are vital for safety and optimal results.

Here are the key preparation steps:

• Metal Removal and Disclosure: This is perhaps the most critical step for any MRI, and even more so in an intraoperative setting where access might be limited during an emergency. Patients must remove all metallic objects before entering the MRI environment. This includes:

  • Jewelry (rings, necklaces, earrings, bracelets)
  • Watches
  • Hairpins, hair clips, and hair extensions with metallic components
  • Spectacles and contact lenses with metallic elements
  • Dentures and removable dental work (implants need to be disclosed)
  • Hearing aids
  • Any clothing with metal components like zippers, buttons, buckles, underwire bras, or metallic threads/microfibers. Ferromagnetic objects can become dangerous projectiles due to the powerful magnetic field, posing a severe safety risk. Moreover, metallic items can significantly interfere with the magnetic field, leading to image artifacts and degraded scan quality, which can compromise surgical guidance.

• Informing Medical Staff about Implants and Devices: It is absolutely crucial for patients to inform their healthcare providers about any metal implants or medical devices they may have, whether surgically implanted or accidentally acquired (e.g., shrapnel). This includes:

  • Pacemakers
  • Cochlear implants
  • Aneurysm clips (especially older, non-MRI compatible ones)
  • Certain prostheses (hip, knee replacements)
  • Vascular stents
  • Neurostimulators
  • Infusion pumps
  • Intrauterine devices (IUDs) Some implants are incompatible with MRI and could malfunction, overheat, or be displaced by the strong magnetic field, leading to serious patient harm. The medical team needs to verify the MRI compatibility of all devices. In cases of non-compatible implants, alternative imaging methods or adjustments to the iMRI protocol may be necessary.

• Medications and Diet: Generally, patients can continue their regular medications and maintain their usual diet unless specifically instructed otherwise by their physician. However, for certain types of MRI scans, such as abdominal scans or those involving contrast dye, fasting for a few hours before the procedure may be required. Your surgical team will provide precise instructions regarding fasting, typically as part of your overall pre-operative preparation.

• Allergies: It is imperative to inform the healthcare team about any known allergies, particularly to contrast materials (gadolinium-based contrast agents) if they are planned for use during the iMRI. Allergic reactions, though rare, can range from mild to severe.

• Pregnancy: Women who are pregnant or suspect they might be pregnant must inform their doctor immediately. While MRI is generally considered safer than X-rays as it does not use ionizing radiation, it is typically avoided during the first trimester of pregnancy as a precautionary measure. Furthermore, contrast dye is generally not recommended during pregnancy due to potential risks to the fetus.

• Claustrophobia: The MRI scanner is a confined space, which can be distressing for patients with claustrophobia. If you experience anxiety in enclosed spaces, discuss this with your doctor beforehand. Sedation may be offered to help you relax and remain still during the scan. While open MRI scanners exist, they are less common in India for complex neurosurgical procedures and may produce slightly inferior image quality compared to high-field closed scanners, which is critical for iMRI.

• Comfort and Stillness: The MRI machine produces loud banging and knocking noises due to the rapid switching of magnetic field gradients. Patients will be given earplugs or headphones to mitigate this acoustic discomfort. It is also crucial for patients to understand the need to lie completely still for the duration of the scan, which can range from 20 to 90 minutes. Any movement can blur the images and necessitate a repeat scan, prolonging the procedure.

• Pre-operative Assessment: As part of the surgical preparation, a comprehensive pre-operative assessment will be conducted. This includes detailed medical history, physical examination, blood tests, and other diagnostic imaging to ensure the patient is fit for surgery and iMRI.

In India, given the significant patient load and sometimes varied levels of patient awareness, it is particularly important for healthcare providers to thoroughly educate patients about these preparation steps to ensure their safety and the efficacy of the iMRI procedure.

The Intraoperative Magnetic Resonance Imaging (iMRI) Procedure

The iMRI procedure is a meticulously orchestrated integration of sophisticated surgical techniques and advanced imaging technology, all taking place within a specialized operating environment. This setup, often referred to as a "Brain Suite," is designed to facilitate seamless transitions between surgery and imaging without compromising sterility or patient safety.

The general steps for an iMRI-guided surgery typically include:

1. Initial Surgery: The surgical team, consisting of neurosurgeons, anesthesiologists, nurses, and technicians, begins the operation as planned. This initial phase involves standard surgical procedures such as craniotomy (opening the skull), exposure of the brain, and initial tumor debulking or lesion identification using conventional microsurgical techniques and neuronavigation systems based on pre-operative images. The goal at this stage is to perform as much of the initial surgical work as possible before the need for intraoperative imaging arises.

2. Patient Transfer for Imaging: When the surgeon determines that intraoperative imaging is required – for instance, to assess the extent of tumor removal, verify anatomical landmarks after brain shift, or to guide further dissection – the surgical activity is temporarily paused. This is a critical and highly coordinated step. The patient, along with all vital sign monitors, anesthesia machines, and life support equipment, is carefully and safely transferred to the imaging area. There are typically two main configurations for an iMRI suite:

   • Fixed Scanner with Patient Transfer: In this setup, the MRI scanner is housed in an adjacent room, separated from the operating room by a common door. The patient, still under anesthesia and connected to monitoring, is meticulously wheeled on a specialized MRI-compatible table through this door into the scanner's bore.
   • Mobile or Swivel Scanner: Some advanced suites feature a fixed MRI scanner with a swivel operating table that rotates the patient directly into the MRI gantry, or a mobile MRI scanner that can be brought into the operating field. This minimizes patient movement and potential disruption. Regardless of the setup, patient safety, maintaining sterility, and continuous monitoring of vital signs are paramount throughout this transfer process.

3. iMRI Scan: Once the patient is positioned within the MRI scanner, an MRI scan is performed. This is not a full diagnostic scan but a targeted sequence designed to generate real-time, high-resolution images of the surgical site. The scan protocols are optimized for speed and clarity, focusing on the areas of interest for the surgeon. These images provide updated anatomical information, accounting for any brain shift that may have occurred and highlighting the current status of the tumor or lesion in relation to surrounding structures. The imaging process is managed by a radiologist or a specially trained MRI technologist, working in close communication with the surgical team.

4. Image Review and Surgical Adjustment: Immediately after the scan, the newly acquired iMRI images are displayed on high-resolution monitors within the operating room. Surgeons meticulously review these images. They compare the intraoperative scans with the pre-operative images and their current surgical progress. This review allows them to:

   • Assess the extent of tumor removal achieved so far.
   • Identify any residual tumor tissue that was previously unseen or obscured.
   • Accurately account for brain shift and update their mental map of the brain's anatomy.
   • Re-plan further surgical steps, adjusting their trajectory or technique based on the new, precise information. Often, these iMRI images are integrated into the existing neuronavigation system, which provides the surgeon with a refreshed, real-time "GPS" for the brain.

5. Continuation of Surgery: Based on the critical new information gleaned from the iMRI, the patient is carefully moved back to the operating table (or the mobile scanner is moved away, or the table swivels back). The surgical team then continues the operation, using the updated images to guide their actions with enhanced precision. This cycle of surgery, scanning, review, and adjustment can be repeated multiple times during a single procedure, especially in highly complex cases, until the optimal surgical outcome is achieved – typically, maximal safe resection of the tumor.

Anesthesia Challenges: Performing iMRI-guided surgery presents unique challenges for the anesthesia team. While general anesthesia is common, certain procedures, like awake craniotomies (where the patient is woken up during surgery to test neurological function), can be more challenging in an iMRI suite due to patient positioning and transfer requirements. A "sleep-awake-sleep" anesthesia pattern might be more suitable, allowing the patient to be sedated during transfer and imaging, awakened for functional testing, and then re-sedated for the remainder of the procedure. The anesthesiologist plays a crucial role in maintaining patient stability and comfort throughout these transitions.

The iterative nature of the iMRI procedure ensures that surgeons are operating with the most accurate and up-to-date information, significantly increasing the likelihood of a successful outcome while minimizing risks.

Understanding Results

The results of an iMRI scan are profoundly impactful because they provide surgeons with immediate, actionable feedback during the operation. This real-time validation and guidance are central to achieving the superior outcomes associated with iMRI-guided procedures.

Here’s how the results are understood and utilized:

• Improved Extent of Resection (EOR): The most direct and significant result of iMRI is its ability to improve the Extent of Resection (EOR) for brain tumors and other lesions. By enabling surgeons to visualize residual tumor tissue mid-procedure, iMRI allows for further removal that might otherwise have been missed. Studies have consistently demonstrated this benefit. For instance, in cases of gliomas, a common and aggressive type of brain tumor, achieving maximal safe resection is strongly correlated with improved patient survival and reduced recurrence rates. Similarly, for pituitary adenomas, iMRI has been shown to significantly enhance EOR, with studies indicating that in a notable percentage of cases (e.g., 25%), iMRI helped achieve a more complete removal, particularly for tumors extending into critical areas. This immediate confirmation of EOR is crucial, as even a small amount of residual tumor can impact prognosis.

• Validation for Surgeons: iMRI provides an invaluable learning and validation tool, especially for younger or less experienced surgeons. The ability to perform a scan, assess the surgical field, and then compare it against their pre-operative plan and initial resection allows them to validate their results intraoperatively. This immediate feedback loop can significantly increase their confidence and proficiency in achieving a higher EOR without an undue increase in complications. It fosters a safer and more effective learning environment, refining surgical judgment and technique in real-time.

• Enhanced Navigation: The iMRI images are often integrated seamlessly with the neuronavigation system used in the operating room. This means that the surgical "GPS" is continuously updated with the latest anatomical information, effectively compensating for brain shift. This enhanced navigation system provides surgeons with a precise, real-time map, allowing them to accurately track their instruments, navigate towards residual tumor tissue, and safely avoid critical neurological structures. This precision is vital for intricate dissections and targeted lesion removal.

• Better Treatment Planning: The detailed images obtained from iMRI provide comprehensive information about the tumor's size, exact location, relationship to surrounding eloquent brain regions, and potential involvement of adjacent structures like blood vessels or lymph nodes. This detailed anatomical and pathological information is critical for accurate cancer staging and for refining post-operative treatment planning. Knowing the precise extent of tumor removal and any remaining microscopic disease allows oncologists and radiation therapists to tailor chemotherapy and radiation therapy regimens more effectively, optimizing the patient's overall treatment strategy.

Post-Surgery Review: After the surgery is complete, a radiologist reviews all the iMRI images, along with any pre-operative and post-operative scans. They then prepare a detailed radiological report, which is sent to the referring physician (the neurosurgeon). This report provides a comprehensive overview of the surgical findings, the extent of resection achieved, and any notable observations from the intraoperative imaging. This documentation becomes a crucial part of the patient's medical record, aiding in long-term follow-up and management.

In essence, iMRI results are not merely diagnostic; they are dynamic tools that actively shape the course of surgery, leading to more complete and safer resections, improved long-term prognoses, and a better quality of life for patients undergoing complex neurosurgical procedures.

Risks

While Magnetic Resonance Imaging (MRI) is generally considered a very safe and non-invasive diagnostic tool, particularly because it does not use ionizing radiation unlike X-rays or CT scans, iMRI, due to its intraoperative nature and the powerful magnetic fields involved, carries specific risks that demand rigorous safety protocols. The unique environment of an iMRI suite, where surgical procedures are combined with a powerful magnet, necessitates heightened vigilance.

Here are the specific risks associated with iMRI:

• Magnetic Field Hazards (Projectile Risk): The primary and most significant risk in an MRI environment is the strong static magnetic field. This field is always "on," even when not scanning. Ferromagnetic objects (materials attracted to magnets, like iron, steel, nickel, cobalt) can be rapidly pulled into the MRI machine with tremendous force, becoming dangerous projectiles. This phenomenon has unfortunately led to severe accidents in India and worldwide, including instances where oxygen cylinders, stretchers, or even metallic implants within individuals were pulled into the MRI bore, causing serious injury or fatality. Strict adherence to MRI safety zones and thorough screening for all personnel and equipment entering the suite is paramount.

• Implant and Device Malfunction: Non-MRI-compatible medical implants or devices pose a significant risk. If a patient has a pacemaker, cochlear implant, certain aneurysm clips, neurostimulators, or other metallic devices that are not certified as MRI-safe (MRI-compatible or MRI-conditional), the magnetic field can cause:

  • Malfunction: Devices like pacemakers can cease to function or switch to unsafe modes.
  • Displacement: Ferromagnetic implants can be pulled from their original position, causing internal injury or bleeding.
  • Overheating: Some devices can heat up, causing thermal injury (burns) to surrounding tissues. Thorough screening and verification of MRI compatibility for all implants are absolutely essential before any iMRI procedure.

• Thermal Injuries (Burns): The radiofrequency (RF) fields generated by the MRI during scanning can cause tissue heating. This risk is amplified if:

  • Conductive Loops: Patients wear clothing containing metallic microfibers, jewelry, or have skin-to-skin contact points that create conductive loops.
  • Improper Positioning: Leads, cables, or monitoring wires touch the patient or form loops. Severe burns can occur, necessitating careful patient positioning, removal of all metallic items, and proper insulation of any necessary conductive leads.

• Peripheral Nerve Stimulation: The rapidly changing gradient magnetic fields used to create images can induce electrical currents in the body, leading to peripheral nerve stimulation. Patients may experience twitching sensations or muscle contractions. While generally not harmful, it can be uncomfortable and potentially disruptive during a delicate surgical procedure.

• Acoustic Noise: MRI machines produce very loud banging, knocking, and whirring noises, which are a normal part of the scanning process. Without proper ear protection (earplugs or headphones), this acoustic noise can cause temporary or even permanent auditory damage.

• Brain Shift Challenges: While iMRI helps address brain shift, the phenomenon itself can complicate navigation. If the iMRI is not performed frequently enough or if the brain shift is particularly dynamic, there might still be minor discrepancies between the iMRI images and the exact real-time anatomy, though far less significant than relying solely on pre-operative scans.

• Anesthesia Challenges: Performing procedures like awake craniotomy in an iMRI suite can be more complex. The need for patient positioning, transfer, and the confined space of the scanner can make it challenging to maintain patient comfort and safety during the "awake" phase. A "sleep-awake-sleep" anesthesia pattern might be more suitable, but requires expert anesthetic management.

• Contrast Agent Risks: If gadolinium-based contrast dye is used to enhance image visibility, there's a small risk of an allergic reaction, ranging from mild hives to severe anaphylaxis. Patients with kidney dysfunction may also be at risk for a rare but serious condition called Nephrogenic Systemic Fibrosis (NSF). Thorough patient screening and allergy history are crucial.

MRI Accidents in India: It is important to acknowledge that MRI accidents are unfortunately prevalent in India. This is often attributed to a combination of factors, including a lack of widespread awareness regarding stringent MRI safety protocols among some staff and patients, and the enormous patient load on MRI infrastructure, which can sometimes lead to rushed procedures or compromised safety checks. Continuous education, strict adherence to international safety guidelines, and investing in MRI-compatible equipment and infrastructure are vital to mitigate these risks. Patient education, as emphasized in the preparation section, plays a critical role in preventing incidents caused by undisclosed metallic items.

Costs in India

The cost of medical procedures in India is a significant consideration for patients. While the specific costs for Intraoperative Magnetic Resonance Imaging (iMRI) are not typically published as a standalone diagnostic test, it is understood to be an integral and advanced component of highly complex surgical procedures, primarily in neurosurgery. Therefore, its cost is integrated into the overall surgical package, which can vary widely.

Here’s a breakdown of factors influencing costs and general MRI pricing in India:

• iMRI as Part of a Surgical Package: iMRI is not a separate charge that one would pay for like a regular diagnostic MRI. Instead, it is an advanced technology employed during a major surgery. Consequently, its cost is subsumed within the comprehensive fees for the neurosurgical procedure itself, which would include surgeon fees, anesthesia, hospital stay, medications, other imaging, and post-operative care. These surgical packages for complex brain procedures can range from several lakhs to tens of lakhs of Indian Rupees, depending on the hospital, city, and complexity of the case.

• Factors Influencing General MRI Scan Costs: To understand the context of iMRI costs, it's helpful to look at general MRI scan pricing in India, which varies significantly based on several factors:

  • Body Part Being Scanned: A brain MRI will have a different cost than a knee MRI or a full-body scan.
  • Use of Contrast Dye: Scans requiring contrast material (gadolinium) are typically more expensive than non-contrast scans due to the cost of the dye and the additional procedure for administration.
  • Type of Hospital or Clinic: Government hospitals or public healthcare facilities generally offer MRI scans at significantly lower costs, often subsidized, compared to private hospitals or diagnostic chains.
  • Technology Used (MRI Machine Strength): The strength of the MRI machine's magnetic field, measured in Teslas (T), impacts cost and image quality.
    • 1.5T MRI machines are common and offer excellent diagnostic quality.
    • 3T MRI machines provide higher resolution and faster scan times but are typically more expensive to operate and thus charge higher fees.
  • City: Costs can vary considerably between metropolitan cities (e.g., Mumbai, Delhi, Bangalore, Chennai) and tier-2 or tier-3 cities due to differences in infrastructure, operational costs, and demand.

• General MRI Scan Cost Ranges in India (Approximate):

  • Average MRI Scan (single body part, non-contrast): Typically between ₹1,500 to ₹8,000.
  • Brain MRI (non-contrast): Averages between ₹3,000 to ₹7,000. With contrast, it can go up to ₹10,000 - ₹12,000.
  • Spine MRI (single segment, non-contrast): Averages between ₹5,000 to ₹8,000. Multiple segments or contrast will increase the cost.
  • Full Body MRI: Can range from ₹10,000 to ₹25,000, depending on the facility and machine.

• India's Indigenous MRI Scanner Initiative: A significant development on the horizon for MRI accessibility and cost reduction in India is the development of the country's first indigenous MRI scanner. This ambitious initiative aims to reduce the reliance on expensive foreign imports, which currently dominate the market. The first such indigenous scanner is expected to be installed for clinical trials at AIIMS-Delhi by October 2025. The long-term goal of this project is to reduce MRI costs for patients by approximately 50%. This could make advanced imaging, including potentially iMRI technology in the future, much more accessible and affordable across the nation.

• Insurance Coverage: Many health insurance policies in India cover MRI scans, especially if they are prescribed during hospitalization as part of a diagnostic or treatment plan. For complex surgeries involving iMRI, the overall surgical package would generally be covered by comprehensive health insurance plans, subject to the policy's terms and conditions, deductibles, and co-payments. Patients are always advised to check with their insurance providers regarding the specifics of their coverage for such advanced procedures.

While iMRI-guided surgeries are undoubtedly premium procedures due to the specialized technology, infrastructure, and expertise required, the long-term benefits of improved surgical outcomes, reduced complications, and decreased need for re-interventions can often outweigh the higher initial costs by enhancing patient quality of life and potentially lowering overall healthcare expenditures over time.

How Ayu Helps

Ayu streamlines your healthcare journey by securely digitizing all your medical records, including detailed iMRI reports, surgical notes, and follow-up plans, ensuring easy access and informed decision-making for you and your healthcare providers.

FAQ

Q1: Is Intraoperative MRI (iMRI) safe? A1: Yes, iMRI is generally considered safe when stringent safety protocols are followed. While MRI itself does not use ionizing radiation, the powerful magnetic fields in an iMRI suite necessitate extreme caution regarding metallic objects and implants. Thorough patient screening for metal, adherence to safety zones, and proper training for all personnel are critical to mitigate risks like projectile accidents, implant malfunction, or thermal burns.

Q2: What is "brain shift" and why is iMRI important for it? A2: "Brain shift" refers to the slight displacement or deformation of brain tissue that can occur after the skull is opened (craniotomy) and cerebrospinal fluid is released during neurosurgery. This shift means that pre-operative MRI images, which surgeons rely on for navigation, no longer perfectly match the brain's real-time position. iMRI is crucial because it provides updated, real-time images during surgery, accurately accounting for brain shift and allowing surgeons to adjust their navigation for precise tumor targeting and avoidance of critical areas.

Q3: Is iMRI only used for brain tumors? A3: While iMRI is predominantly used and highly beneficial for brain tumor resections (like gliomas and pituitary adenomas), its applications are expanding. It is also used in surgeries for pediatric brain tumors, epilepsy (to target seizure-causing regions), movement disorders like Parkinson's disease, dystonia, and essential tremor (for precise electrode placement in Deep Brain Stimulation), and certain neuropsychiatric disorders.

Q4: How long does an iMRI-guided surgery take? A4: An iMRI-guided surgery typically takes longer than a conventional surgery for a similar condition. This is because the procedure involves pauses for scanning, patient transfer to and from the MRI scanner, and careful review of the images by the surgical team. The iterative nature (surgery-scan-review-continue surgery) means the total operating time can be extended, often ranging from several hours to a full day, depending on the complexity of the case and the number of scans required.

Q5: Will I be awake during the iMRI scan? A5: Most iMRI-guided surgeries are performed under general anesthesia, meaning you will be asleep during the entire procedure, including the scans. In some specific cases, like awake craniotomies, a "sleep-awake-sleep" anesthesia pattern might be used, where you are briefly awakened for functional testing, but typically sedated during the actual iMRI scans and transfers. Your anesthesia team will discuss the best approach for your specific surgery.

Q6: Are there any alternatives to iMRI for neurosurgery? A6: Before iMRI, surgeons relied solely on pre-operative MRI or CT scans integrated with neuronavigation systems. While these are still standard, they do not account for brain shift during surgery, which is iMRI's key advantage. Other intraoperative imaging modalities like intraoperative ultrasound can provide real-time feedback but offer lower resolution and less comprehensive anatomical detail compared to iMRI. For maximum precision and confirmation of resection, especially in complex cases, iMRI is considered the gold standard.

Q7: Can I have an iMRI if I have metal implants? A7: It depends on the type of metal implant. It is absolutely crucial to inform your medical team about all implants (e.g., pacemakers, cochlear implants, stents, aneurysm clips). Many modern implants are "MRI-conditional" or "MRI-compatible," meaning they are safe under specific MRI conditions. However, some older or specific types of implants are "MRI-unsafe" and can malfunction, overheat, or be displaced by the strong magnetic field, posing serious risks. Your medical team will thoroughly screen you and verify the MRI compatibility of all your implants before proceeding with an iMRI.

Q8: What is the main benefit of iMRI for patients? A8: The main benefit of iMRI for patients is significantly improved surgical outcomes. It leads to a higher extent of tumor resection (more complete removal), which is crucial for reducing tumor recurrence and improving long-term survival rates. Additionally, by providing real-time guidance, iMRI helps surgeons minimize damage to healthy brain tissue, thereby reducing the risk of neurological complications and leading to a faster, smoother recovery and better quality of life post-surgery.