The current challenge

The specialist team of paediatric neurosurgeons at Southampton Children’s Hospital currently rely on MRI scans taken before surgery to guide them to the area of the brain requiring treatment. However, the brain is likely to shift during surgery, so pre-surgical imaging is no longer accurate as the operation progresses.

It isn’t till another scan is taken in the days after surgery that surgeons can finally see if the operation was successful. The child often has to remain sedated on the paediatric intensive care unit throughout this period, while their parents are anxiously waiting for results and facing the fear of further invasive surgery.

How can iMRI Help?

The iMRI is a vital piece of technology that enables surgeons to overcome some significant challenges by enabling real-time image scanning whilst the child is still in surgery.

The precision and accuracy of intra-operative MRI guides the surgeon when removing a brain tumour and other abnormal tissue, whilst being careful not to damage healthy tissue. The real-time imaging prevents a child being sedated for longer than needed and reduces the potential risk of another anaesthetic and further invasive operations to remove any remaining tumour or abnormality. There is a greater chance of totally removing the tumour in that first operation, and a child is more likely to be treated successfully.

iMRI technology is not just used for children with brain tumours but also with other life threatening or life limiting conditions such as trauma, hydrocephalus and epilepsy. Important research will also help unlock how iMRI technology can be used to diagnose and monitor mental health issues, ranging from depression to PTSD, therefore benefitting a greater reach of patients.

Artificial Intelligence (AI) and iMRI

AI is starting to become a reality in the world of medical imaging. There are numerous benefits of combining AI and iMRI:

• Assisting neurosurgeons to predict those children who will benefit most from iMRI, helping with decision making and diagnosis.
• Classification of normal and abnormal tissue.
• Location of abnormalities if the brain has shifted during surgery.
• Outcome predictions after surgery – guiding how best to treat and manage the patient after surgery, in the short and long-term.
• Improving technology – deciding which iMRI techniques worked well and which didn’t and optimising as a result.

However, further research is required and the proposed iMRI Suite will be used to carry out a study into how AI can be used to benefit paediatric patients undergoing neurosurgery.

This will not only benefit local paediatric patients but will also deliver data and findings that can potentially be applied to patients anywhere in the world, and help surgeons globally with future clinical management of their patients.

Augmented Reality (AR) and iMRI

The new iMRI Suite, will support research in the use of augmented reality in neurosurgery.

The use of this pioneering technology in neurosurgery is still in its infancy, but AR has the ability to revolutionise the way that neurosurgeons plan and perform surgical procedures.

The surgeon, wearing a head mounted display, is provided with a smart view of the patient with live images augmented with graphical representations of anatomical structures taken from imaging data. This provides the surgeon with a better view of the tumour and/or location being operated on.

This in-situ visualisation, where the computer maps the image information onto the patient, promises the most direct, intuitive guidance for surgical procedures and could be vital to the success of surgery and positive patient outcomes.