Nuffield Orthopaedic Centre installs world's first room-size MRI scanner
12 November 2005
Melville, NY. The Nuffield Orthopaedic Centre (NOC) in Oxford, England is
installing a room-size magnetic resonance (MR) imaging unit, the Fonar 360,
in a recently completed facility specially built for it. NOC will be the
first beta test site for the clinical evaluation and clinical implementation
of the FONAR 360. Its first applications will be orthopaedic MR imaging and
the development of MR image guided intraoperative techniques for surgery of
the spine and other orthopaedic structures.
The FONAR 360(TM) will be the centerpiece of what will be the world's
first room-size MR scanner in which surgeons and radiologists will have full
and unimpeded 360 degree physical access to the patient for performing MR
image guided surgical procedures.
Raymond Damadian, MD, president and founder of FONAR Corporation said,
"The installation of the FONAR 360(TM) is a major milestone for FONAR. We
are very excited about it, particularly because of the benefits we believe
it holds for patients in need.
"Most significantly, the FONAR 360(TM), unlike any other MR imaging
system, is a magnet the doctors can walk inside of. The patient is
positioned on a customary surgical table but the table itself is positioned
immediately on top of one of the two magnet poles of the MR unit. Because of
this design, the entire surgical team consisting of surgeons,
anesthesiologists, OR nurses and their surgical support systems, including,
as needed, respirometers, heart pumps, cardiopulmonary bypass units,
lithotriptors, surgical navigation systems, endoscopy systems, anesthesia
carts, arthroscopy units, defibrillators, thermal regulation systems,
fiberoptic lighting systems, and electrophysiology platforms such as EEG,
EKG and EMG systems, have full 360(degree) access to the patient.
"Thus, the surgical team may proceed with their intraoperative procedures
under direct MR image guidance throughout, and direct their instruments
through the body and within the body's organs with continuous MR image
monitoring of their position within the body as the procedure progresses.
"Full 360 degree access and the ability of the surgical team to walk
within the MR magnet is unprecedented and not available in any other MR
imaging system. The Nuffield Orthopaedic Centre system will be pioneering
the first of these.
"Most importantly, the possibility of direct intraoperative monitoring by
MR imaging adds a critical dimension to the intraoperative procedure. In
general, all operative procedures suffer from the limitation that visibility
of the body's organs is limited to the surface of the organ. They are not
transparent and are opaque to visible light. Diseased tissues WITHIN the
organ, such as tumours, cannot be visualized at surgery without the surgeon
cutting into the organ. For example, a surgeon looking at the liver in the
operating room sees only the liver's surface. He cannot see INTO the liver.
He must cut into the liver, a tissue destroying step, if he wants to see the
tumour directly in order to remove it. Similarly, within the breast and
brain, for example, tumours inside of these organs cannot be directly
visualized by the operator for the purpose of removing them, without the
operator cutting into these organs and destroying tissue in the process.
Optical instruments such as the endoscope, laparoscope and surgical
microscope all have the same limitation. The interior of the body's organs
are opaque to visualization by these optical devices for the same physical
reasons they are optically opaque to the human eye.
"The FONAR 360(TM) overcomes this intraoperative impediment. The MR image
sees the full interior of any organ in 3 dimensions with submillimeter
resolution. It therefore can see the exact position of the surgeon's needle,
trochar or scalpel inside the organ as the operative process proceeds, very
much improving his prospects when it comes to tumour surgery of "getting it
"The Nuffield Orthopaedic Centre (NOC) will be the first beta test site
for the clinical evaluation and clinical implementation of the FONAR
360(TM). Its first applications will be orthopaedic MR imaging and the
development of MR image guided intraoperative techniques for surgery of the
spine and other orthopaedic structures.
"Important additional benefits for the treatment of tumours are made
available by the introduction of the FONAR 360(TM). Currently, systemic
(oral) chemotherapy and its success must cope with several impediments.
1. When a chemotherapy agent is given by mouth there is no means to
certify that the agent actually reached the target organ.
2. More importantly, there is no way of ascertaining what dose level was
achieved within the target organ and for how long the required dose level
was maintained within the tissue without being washed out.
3. Additionally, because it is given by mouth (systemically) the actual
dose the patient receives is often limited by the toxic side affects on the
body's healthy tissues.
"The FONAR 360(TM) being implemented at the Nuffield Orthopaedic Centre
has the prospect of getting past these impediments.
"With the availability of MR image guidance, the intraoperative process
made possible by the FONAR 360(TM) and its 360 degree open access to the
patient by the operative team, needles can now be relatively easily
introduced directly into the tumour or tumours by means of intraoperative MR
image guidance. The dose, readily calculated from the number of cc's
injected into the tumour, assures that the pharmaceutical agent has reached
the tumour at the required dose level. A magnetic tag such as gadolinium
injected with the agent will show the agent on the MR image and enable the
surgeons or post-operative teams to measure the rate of "washout" of the
chemotherapy agent. Additionally, direct injection and exclusive delivery of
the chemotherapeutic agent to the tumour circumvents the toxic effects of
the agent on the body's other healthy organs and bypasses these toxicities
that limit the dose that can be given to the patient when the
chemotherapeutic agent is given by mouth.
"For this reason, namely the avoidance by direct injection of the dose
limiting toxicity of systemic treatments, it is likely that much higher
doses of the chemotherapeutic agent may be achievable within the tumour.
Additionally, tumour tissue dose levels can be continually monitored
quantitatively by MR imaging of the gadolinium enhanced tumour to determine
the degree to which effective dose levels are being maintained within the
tumour. Once the needle has been successfully placed within the tumor, the
needle itself can be replaced with a permanent indwelling catheter for the
delivery of follow-up doses of the chemotherapy agent (or other anti-tumor
agents e.g. angiogenesis inhibitors, immunotherapy agents, etc.) to certify
by post-operative MR imaging that effective dose levels of the anti-tumor
agent are being achieved within the tumor and maintained throughout the
course of therapy.