An Image-Guided Tour Through BWH’s Advanced Multimodality Image Guided Operating (AMIGO) Suite

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An Image-Guided Tour Through BWHsAdvanced
Multimodality Image Guided Operating (AMIGO) Suite

• Image Guided Therapy Program
• Department of Radiology
• Brigham and Womens Hospital

PET/CT Room
Operating Room
MRI Room
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Supported by

• National Center for Image Guided Therapy (NCIGT)
  P41 RR019703 (Jolesz, Tempany) 2005-2015

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Credits

• This presentation researched and created by
  Mallika Winsor
• Photographs by Junichi Tokuda and Dan Kacher

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From Conceptualized Sketch
...To Completed Suite
Advanced Multimodality Image Guided Operating
(AMIGO) Suite P41 RR019703 National Center for
Image Guided Therapy (NCIGT) 2005-2015 Ferenc
Jolesz, MD Clare Tempany, MD
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The OR and MR rooms of AMIGO
Advanced Multimodality Image Guided Operating
(AMIGO) Suite P41 RR019703 National Center for
Image Guided Therapy (NCIGT) 2005-2015 Ferenc
Jolesz, MD Clare Tempany, MD
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Imaging Equipment in AMIGO

• Room 1 MRI Room
• Siemens 3T Verio MR scanner that moves along a
  ceiling track between the MRI room and the OR
• Room 2 PET-CT Room
• Siemens PET-CT
• Room 3 Operating Room
• BK Medical Pro Focus UltraView Surgical
  Ultrasound with Prostate Transducer
• Siemens S2000 Ultrasound
• Siemens Artis Zee ceiling mounted X-ray
  Fluoroscopy system with Navigation Package and
  DynaCT
• Zeiss Pentero surgical microscope
• Navigation
• BrainLAB navigation system
• Sentinelle Medical (Hologic) Aegis Navigation
  Workstation
• St Jude Medical mapping and navigation system
• IntraMedical Imaging Node Seeker and Beta Probe
• Robin Medical Endoscout

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The OR and MR rooms of AMIGO
Advanced Multimodality Image Guided Operating
(AMIGO) Suite P41 RR019703 National Center for
Image Guided Therapy (NCIGT) 2005-2015 Ferenc
Jolesz, MD Clare Tempany, MD
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Magnetic Resonance Imaging (MRI)
Goal Highly detailed anatomical images

• What Does It Do?

• Strong magnetic field is applied, causing the
  nuclei within the patients body to rotate and
  align
• Scanner detects, records, and combines the
  different rotating fields into a single image
• Gradients in all directions are combined to
  create a 3D image
• Strong contrast between different soft tissues
  within body
• Better at producing images of brain, muscles,
  heart, cancers than CT or x-rays

• Applications
• Used to distinguish pathological tissue from
  normal tissue
• Comparable resolution, much better contrast
  resolution (between arbitrarily different but not
  identical tissues) than CT
• Advantages
• Harmless to patient
• What it uses
• Strong magnetic fields
• Non-ionizing radiation

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Magnetic Resonance Imaging (MRI)Terminology

• Parameters of Image Acquisition

• Edema

• TE echo time
• TR repetition time
• TI inversion time
• Time between inversion and excitation pulses

• Abnormal accumulation of fluid beneath the skin
  or in cavities of the body
• Caused by increased secretion of fluid into the
  interstitium or impaired removal of fluid

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Magnetic Resonance Imaging (MRI)Basic Scans

• T1-weighted MRI scan

• T2-weighted MRI scan

• Highlights fat deposits
• Water dark fat bright
• Good grey v. white matter contrast
• Commonly run clinical scan
• Short TE short TR

• Highlights fluids
• Fat dark water light
• Good for imaging edema
• Heavily used for clinical scans of cerebral
  spinal fluid
• Long TE long TR

T2-weighted MRI scan
Spin density weighted MRI scan

• Gradient Echo (GRE) sequence
• Additional loss over T2 decay
• Air/tissue boundaries susceptible
• Increases contrast of specific tissues
• Long TE long TR

• No contrast from either T1 or T2 decay
• Uses spin echo (sometimes gradient echo)
  sequences
• Short TE long TR

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Magnetic Resonance Imaging (MRI)Specialized Scans

• Diffusion MRI scan

• Fluid Attenuated Inversion Recovery (FLAIR)

• Diffusion tensor imaging (DTI) enables diffusion
  to be measured in multiple directions
• Make brain maps of fiber directions
• Examine connectivity of different regions of
  brain
• Examine areas of neural degeneration and
  demyelination

• Inversion-recovery pulse sequence that nulls
  fluid signals
• Free water dark edematous tissue bright
• Most sensitive way to evaluate brain for
  demyelinating diseases
• Carefully-selected TI allows signal from any
  particular tissue to be suppressed
• Conversion of T2-weighted sequence via additional
  radio frequency pulse and manipulation of
  magnetic gradients

Functional MRI (fMRI)

• Measures signal changes in the brain due to
  changing neural activity
• Low resolution, rapid rate scans
• BOLD (Blood-Oxygen-Level Dependent) effect
• Increases in neural activity cause changes in MR
  signals via T2 changes
• Increased neural activity increases demand for
  oxygen
• Vascular system overcompensated, increasing
  oxygenated hemoglobin
• High resolution 3D maps of venous vasculature
  within neural tissue

Real-Time MRI

• Continuous monitoring ("filming") of moving
  objects in real time
• Should help provide information about diseases of
  the joints and heart
• May make MRI examinations easier and more
  comfortable for patients

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Magnetic Resonance Imaging (MRI)Medical
Applications

• Interventional Therapy

• Radiation Therapy Simulation

• MRI images used to guide minimally invasive
  procedures both intraoperatively and
  interactively
• No ferromagnetic instruments used
• Some specialized systems allow imaging concurrent
  with surgery
• Usually, surgical procedure is temporarily
  interrupted so MR images can be acquired to
  verify success/guide subsequent surgical work

• MRIs used to specifically locate tumors within
  body in preparation for radiation therapy
  treatments
• Patient placed in specific, reproducible, body
  position and scanned
• MRI system computes precise location, shape and
  orientation of the tumor mass, correcting for
  spatial distortion inherent in the system
• Patient is marked/tattooed with points that, when
  viewed in specified, reproducible body position,
  permit precise triangulation for radiation therapy

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Magnetic Resonance Imaging (MRI)

• What is MRI Compatibility?

• Safety Concerns

• MR-Safe device or implant that is completely
  non-magnetic, non-electrically conductive, and
  non-RF reactive
• Titanium and its alloys
• MR-Conditional device that is safe, provided
  the safety conditions are defined and observed
• MR-Unsafe objects that are significantly
  ferromagnetic and pose a clear and direct threat
  to persons and equipment within the magnet room
• Patients always asked for complete information
  about all implants prior to entering the MRI suite

• Radio frequency energy
• Powerful radio transmitter can heat the body to
  the point of risk of hyperthermia in patients
• Peripheral Nerve Stimulation
• Rapid switching on and off of the magnetic field
  gradients may cause nerve stimulation
• Acoustic noise
• Appropriate ear protection is necessary for
  anyone inside MRI scanner room during examination
• Cryogens
• Cryogenic (extremely cold) liquids enable
  superconducting capabilities of the
  electromagnetic coils
• MRI support rooms should be equipped with
  pressure relief mechanisms and an exhaust fan in
  case of a quench (shut-down of superconduction
  electromagnet)
• Pregnancy
• Increasingly important for diagnosing and
  monitoring congenital defects of the fetus (no
  contrast agents used)
• Fetal tumors (primarily teratomas)
• Facilitating open fetal surgery
• Other fetal interventions
• Planning to safely deliver and treat babies whose
  defects would otherwise be fatal

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Siemens MAGNETOM Verio 3T
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AMIGOs MRISiemens MAGNETOM Verio 3T

• Who Can It Accommodate?

• How Does It Help BWH?

• Patients up to 550 lbs
• Pediatric and elderly patients
• Claustrophobic patients
• Intensive Care Unit patients
• Patients dependent upon medical equipment

• Minimizes scan rejections due to claustrophobia
• Reduces necessary sedations
• Capture sharper images (due to reduced
  anxiety-related movement)
• Early access in interventional MRI
• Opportunities to perform more kinematic studies

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AMIGOs MRISiemens MAGNETOM Verio 3T

• Features ?

• Why this machine?

• VQ engine
• Ultra-light (6.3 tons) magnet with zero helium
  boil-off
• Total Imaging Matrix (TMI)
• TrueForm design
• Larger imaging volume, higher image quality,
  better fat saturation
• Whole body imaging up to 6' 4
• Shortest 3T system available
• 70 cm Open Bore
• Moves along ceiling into OR

• Higher speed, increased image quality
• Safer scanning environment
• Increase flexibility, accuracy and speed
• Enhanced image quality for a wide range of
  applications
• Ensures uniform RF distribution in all body
  regions (optimizes homogeneity)

Bottom Line Exceptional diagnostic
capabilities, patient comfort, and efficient
workflow
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A view of OR table and the MR through the PET/CT
Bore
Advanced Multimodality Image Guided Operating
(AMIGO) Suite P41 RR019703 National Center for
Image Guided Therapy (NCIGT) 2005-2015 Ferenc
Jolesz, MD Clare Tempany, MD
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Positron Emission Tomography-Computed Tomography
(PET-CT)
Goal Precise localization of metabolic functions

• What Does It Do?

• How Does It Work?

• Hybrid modality of PET and x-ray CT
• Takes both types of images sequentially, in the
  same session
• Images can be combined into a single 2D or 3D
  superposed image
• Detecting changes in molecular activity
• Reveal primary tumors
• Detect metastases
• Quantify uptake
• Improves accuracy in oncology, surgical planning,
  radiation therapy, cancer staging
• Increased image quality, speed, and accuracy of
  diagnosis

• Patient fasts for 4 hours or more
• Intravenous bolus (tracer) injected patient's arm
• 1-2 hours later, patient placed into PET-CT,
  usually with arms at the sides or above the head
• Automatic bed moves head first into the gantry,
  first obtaining a topogram (whole body flat
  sagittal section)
• Operator uses PET-CT console to identify patient
  and examination, selects the scanning parameters
  and starts image acquisition period
• Patient automatically moved head-first into CT
  gantry, where x-ray tomogram is acquired
• Patient automatically moved through PET gantry,
  parallel to CT gantry PET slices acquired
• Software reconstructs/aligs PET and CT images
• Whole body scan (mid-thigh to top of head) takes
  5-40 min

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Positron Emission Tomography-Computed Tomography
(PET-CT)

• Positron Emission Tomography

• X-ray Computed Tomography

• Uses radionucleotide decay to generate 3D image
  of functional processes in the body
• Detects gamma rays emitted by a positron-emitting
  radionucleotide ("tracer")
• Tracer enters patient's body via a biologically
  active molecule
• FDG is a tracer used to display metabolic
  activity of tissue in terms of regional glucose
  uptake
• Computer analyzes location/concentration of
  tracer within patient to construct 3D images

• Uses computer processed tomography to generate 3D
  images from a collection of 2D x-ray images taken
  around a single axis of rotation
• Tomography imaging by sections
• Supplements x-rays and medical ultrasonaography
• Used in preventative/screening medicine

TIME Magazine declared PET-CT "Medical Invention
of the Year" in 2000
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AMIGOs PET-CTSiemens Biograph TruePoint

• Features ?

• Benefits

• World's first HD PET platform
• 190 cm patient scan range
• 6-, 16-, 40- or 64- slice CT
• 0.33 second rotation time on 64-slice CT
• Customizable
• Multisclice CT configurations,
• High or standard resolution options
• Clinical configuration options
• 21.6 cm axial PET field of view with TrueV
• Best NEMA spatial resolution in the industry
• 2 mm uniform PET resolution
• 2x improvement signal-to-noise
• Distortion-free throughout entire field of view
• More accurate visualization of fine detail at all
  angles

• Extremely sharp, highly-detailed images
• Wide range of performance options
• Largest PET field of view in the industry,
  increasing count rate performance by over 70
• 10 minute whole-body PETCT imaging with TrueV
• Exceptional lesion detectability
• More accurate visualization of fine detail at all
  angles
• Enhanced detectability and highest level of
  detail
• Sharper images
• Greater distinction within image

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AMIGOs PET-CTSiemens Biograph TruePoint

• Technological Features

• Lutetium Scintillator Oxyorthosilicate (LSO)
  crystal
• Faster scans
• HI-REZ
• Exceptional resolution
• TrueV
• Longest axial field of view available
• TrueC
• Model-based scatter correction

• Ultra-Fast Ceramic (UFC) detector
• Stunning CT image quality
• SureView
• Maximum image quality at any scan speed
• CARE Dose4D
• Real-time dose modulation
• z-Sharp
• Highest spatial resolution available

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Siemens Artis Zee Ceiling-Mounted C-Arm,
Operating Table and MRI in OR of AMIGO
Advanced Multimodality Image Guided Operating
(AMIGO) Suite P41 RR019703 National Center for
Image Guided Therapy (NCIGT) 2005-2015 Ferenc
Jolesz, MD Clare Tempany, MD
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AMIGOs AngiogramSiemens Artis Zee
Ceiling-Mounted C-Arm

• Features

• 56" full-color medical-grade screen

• Large flat detector
• Easy patient access
• Full body coverage
• Ergonomically designed controls

• View multiple inputs simultaneously
• Get the "whole picture" directly, at tableside
• Change layout according to individual workflow
  step
• Extremely high resolution (4x that of standard
  HD)
• 8 megapixel resolution at 4 x HD (3840 x 2160
  pixels)
• Over 200 layout combinations
• 21 video source inputs
• Fully integrated tableside control

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Siemens Artis Zee Ceiling-Mounted C-Arm
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AMIGOs AngiogramSiemens Artis Zee
Ceiling-Mounted C-Arm

• CARE program

• Reduces patient and operator radiation dose to a
  minimum
• Addresses broader patient base of dose-sensitive
  patients (ex children)
• Provides dose monitoring during procedure
• Enhances in-house reporting
• Standard with all Artis Zee systems

• Imaging
• Improved visualization of therapeutic devices
• Advanced 3D applications, allow greater speed and
  precision
• Workflow
• Ergonomically designed controls
• Streamline workflow, increased efficiency

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Ultrasound

• What is Ultrasound?

• Applications

• Cyclic sound pressure with a frequency (20 kHz -
  200 MHz) greater than the upper limit of human
  hearing (typically 20,000 hertz in healthy young
  adults)
• Uses many different fields to penetrate a medium
  and measure the reflection signature or supply
  focused energy
• Reflection signature can reveal details about the
  inner structure of the medium
• This property is used by bats to locate prey
  while hunting
• Most well-known application is use in sonography
  to image a fetus in a human womb
• Diagnostic sonography (AKA ultrasonography)
  ultrasound-based diagnostic imaging technique
  used to visualize subcutaneous body structures
  such as tendons, muscles, joints, vessels and
  internal organs for possible pathology or
  lesions)
• Able to determine size, structure, and any
  pathological lesions using real-time tomographic
  images

• Soft tissue imaging
• Cardiac (heart)
• Renal (kidney)
• Hepatic (liver and gallblader)
• Muscuko-skeletal (muscles, ligaments, tendons)
• Ophthalmic (eyes)
• Superficial (just under the skin) structures
• Ex testicles, thyroid, salivary glands, lymph
  nodes
• Guiding interventional procedures in real time
• Fine needle aspiration/biopsy (FNA/NAB)
  diagnostic procedure
• Biopsy of masses for cytology or histology
  testing in breast, thyroid, liver, kidney, lymph
  nodes, muscles, joints

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Ultrasound

• Obstetric Imaging

• Emergency Ultrasound

• Used to identify many conditions harmful to both
  mother and fetus
• Risk of leaving such conditions undiagnosed is
  far greater than the small risk associated with
  undergoing the actual US scan
• Primary uses
• Assess gestational age
• Confirm fetal viability
• Determine location of fetus, intrauterine v.
  ectopic (displaced anywhere besides uterine wall)
• Check the location of the placenta in relation to
  the cervix
• Detect multiple pregnancies
• Detect major physical abnormalities
• Assess fetal growth for evidence of intrauterine
  growth restriction (IUGR)
• Check for fetal movement and heartbeat
• Determine the sex of the baby

• Specialized application by emergency responders
  to guide immediate first aid care
• Pros
• Images muscle, soft tissue, and bone surfaces
  well particularly good at delineating interfaces
  between solid and fluid-filled spaces
• Renders "live" images, helps narrow down problem
  area
• Determines severity and sources of trauma within
  region
• Portable, narrowly-focused, easy to use
• Cons
• Cannot penetrate bone
• Depth of penetration limited, especially in obese
  patients
• Operator-dependent (high skill needed for good
  quality images and accurate diagnoses)
• Scanning methodologies
• Focused Assessment with Sonography for Trauma
  (FAST)
• Detects internal bodily fluid in between organs
  in cases of blunt abdominal trauma
• Screening test for blood around the heart or
  abdominal organs after trauma
• CARDIASOUND
• Detects blockages/clots/penetrations of the heart

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Ultrasound

• Biomedical Applications

• Detection of pelvic abnormalities, involving
  abdominal/vaginal/rectal US
• Break calculi (stones formed in the body) into
  fragments small enough to be passed without
  excessive difficulty via lithotripsy
• Ablate tumors non-invasively via High Intensity
  Focused Ultrasound (HIFU)
• Magnetic Resonance-Guided Focused Ultrasound
  (MRgFUS) guided by MRI, a lower frequency
  (250-2000 kHz) than medical diagnostic ultrasound
  is applied in significantly higher time-averaged
  intensities
• Acoustic Targeted Drug Delivery (ATDD) enhanced
  transportation of molecules across specified
  tissues via high frequency ultrasound (frequency
  1-10 MHz sound intensity 0-30 watts/cm2)
• Cataract treatment via phacoemulsification
  (surgery in which the eye's internal lens is
  emulsified with an ultrasonic handpiece and
  aspirated from the eye aspirated fluids replaced
  with balanced salt solution)
• Low-intensity pulsed ultrasound used to stimulate
  bone and tooth regeneration, disrupt blood-brain
  barrier for drug delivery
• Ultrasound-guided sclerotherapy and endovenous
  laser treatment
• Ultrasound-guided sclerotherapy ultrasound is
  used to visualize the underlying vein, allowing
  the physician to deliver and monitor the
  injection of the vein-shrinking drug
• Endovenous Laser Treatment (ELT)
  minimally-invasive ultrasound-guided technique
  used to treat varicose veins with laser energy
• An optical fiber is inserted into the vein to be
  treated, a laser light is shone into the interior
  of that vein, causing the vein to contract
  optical fiber is slowly withdrawn
• Elastography non-invasive method in which
  stiffness or strain images of soft tissue are
  used to detect and classify tumors
• When a mechanical compression or vibration is
  applied, the tumor deforms less than the
  surrounding tissue (strain in the tumor is less
  than that in the surrounding tissue)
• Elasticity can discern health from unhealthy
  tissue in specific organs/growths

• Ultrasound Identification (USID)
• Real Time Locating System (RTLS) or Indoor
  Positioning System (IPS)
• RTLS used to wirelessly track and identify the
  location of objects in real time
• Does not include speed, direction, or spatial
  orientation
• IPS network of devices used to wirelessly
  locate objects or people inside a building
• Nonlinear propagation effects
• US waves usually display nonlinear propagation
  (distortion) due to their high amplitude to
  wavelength ratio
• Safety Concerns
• Occupational exposure to ultrasound in excess of
  120 dB may lead to hearing loss
• Exposure in excess of 155 dB may produce heating
  effects harmful to the human body
• Exposures above 180 dB may lead to death
• Recommended to avoid routine use of ultrasound
  scans in low risk pregnancies

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AMIGOs Ultrasound 1BK Pro Focus UltraView

• Capabilities

• Features

• Locate and map lesions, evaluate blood flow,
  biopsy suspicious areas
• Easy-to-create images for accurate diagnosis
• Full line of specialized transducers
• Breast, abdominal, vascular, cardiac, obstetric,
  gynecological
• Compatible with many other contrast-enhancing
  transducers
• Monitor therapeutic interventions
• Breast biopsy, cyst drainage, radioactive seed
  implantation, other therapies (RFA, cryotherapy,
  microwave, laser)
• Guide tip of catheter during RF ablation and
  drainage
• Intuitive keyboard and simple user interface
  makes scanner simple to learn and use
• Compact, mobile design
• High contrast imaging
• HistoScanning interface

• IQPAC technology (for abdominal imaging)
• Angular Compound Imaging (ACI) organ definition
• Reduced presence of artifacts, shadowing and
  speckle
• Compounds images from up to 5 different angles
  into a single, enhanced image
• Enhances anatomical structures (tissue structure,
  vessel borders) during acquisition
• Enhanced Tissue Definition (ETD) reduced speckle
  noise
• Smooth out potential irregularities in an image
• Speckle suppression algorithm continuously
  analyzes ultrasound image for irregularities,
  then smoothes them out without loss of frame rate
• Improved anatomically correct continuous border
• Improved ability to visualize lesion margins

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AMIGOs Ultrasound 1BK Pro Focus UltraView

• Specifics

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Ultrasound Transducer 1BK 8818 Triplane
Prostate

• Features

• Applications

• Images all three prostate planes
• Switches between planes at the click of a button
• Increases diagnostic value with 3D, Contrast and
  Doppler
• Sterile single-use needle guides
• Individually sterile-packed, pre-assembled and
  ready to use
• UA1322-S Biplane guide
• Simultaneously biopsy the peripheral, transition
  and central zones
• UA1323-S Endfire guide
• Apical biopsies
• UA1329-S Dual guide
• Minimal manipulation
• All are suitable for 17G needles

• Transrectal prostate scanning
• Transrectal puncture and biopsy
• Transperineal puncture and biopsy
• Transvaginal scanning
• Spectral and CFM Doppler examinations
• Tissue harmonic imaging
• Contrast imaging

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Ultrasound Transducer 1BK 8818 Triplane
Prostate

• Specifications

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Ultrasound Transducer 2BK 8838 Endocavity 3D

• High Resolution Color and 3D Imaging
• World's first electronic transducer, for
  endovaginal, endoanal and transrectal imaging,
  with built-in high resolution 3D
• Built-In 3D Acquisition
• Built-in linear array rotates 360 inside the
  transducer
• No need for additional accessories or mover
• No moving parts come in contact with the patient,
  for excellent patient comfort
• Unsurpassed Image Quality
• For both dynamic 2D and 3D scanning
• Wide frequency range 12- 4 mHz, excellent imaging
  capabilities across all frequencies
• Enhanced focus capabilities for prostate 3D and
  pelvic floor imaging
• Premium Ease
• Slim 16mm diameter for more comfortable patient
  imaging
• Easy to hold and manipulate
• 2D scanning plane controlled remotely from the
  system keyboard
• Silent operation

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Ultrasound Transducer 2BK 8838

• Specifications

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Ultrasound Transducer 3BK 8848 Intracavity

• A resolution revolution in image guided prostate
  therapy. Resolute, clear and detailed images of
  the prostate, for accurate volume studies and
  source dose planning
• Image guided prostate therapy
• Sagittal scanning of any size prostate from base
  to apex
• Resolute, clear, detailed image for accurate
  volume studies and source dose planning
• Customizable sagittal grids and preferences for
  brachytherapy
• Clear visualization of seminal vesicles
• Clear view of needle placement
• Pelvic Floor scanning
• Best broad view of anterior and posterior
  compartments for functional and anatomical
  studies
• Reproducible 3D studies with external mover
• Detailed high-resolution biplane with 6.5 cm
  linear and convex views
• Applications
• Prostate brachytherapy
• Transrectal scanning
• Transperineal puncture
• Transvaginal scanning
• Prostate cryotherapy
• Spectral and CFM Doppler
• Contrast imaging

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Ultrasound Transducer 3BK 8848 Intracavity

• Specifications

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Microscope
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AMIGOs MicroscopeZeiss OPMI Pentero

• Features

• Intraoperative Fluorescence technologies (enhance
  efficiency via vital info)

• Intra-operative fluorescence
• Integration of entire digital video chain
• Integration of surgical microscope into
  hospital's information and communication
  infrastructure
• User-friendly solutions for OR staff

• INFRARED 800 Fluorescence-based angiography
• Immediately visualize and interpret
  intraoperative blood flow
• Delivers critical information quickly and
  conveniently to surgeon
• No procedural disruption
• Specially tailored to requirements of
  neurosurgery for management of vascular diseases
  (Ex cerebral aneurysms, arteriovenous
  malformations (AVM, and bypass procedures)
• Button activates INFRARED and guides it
  automatically to the point of interest
• Digital videos saved automatically
• Still images easily taken and transferred to
  DVD/USB
• AutoRecord synchronous video of white light and
  infrared view
• AutoGain brightness of infrared image
  automatically adjusted to respective application
• AutoReplay repeat function jumps directly to
  start of inflow on video, skips over blank
  recording
• Picture-in-Picture direct comparison of white
  and infrared recordings on touch screen
• Completely integrated into OPMI Pentero
• FLOW 800 Visual analysis of vascular blood flow
  dynamics
• Analytical visualization tool for rapid and
  reliable interpretation of fluorescence video
  sequences generated using INFRARED 800
• Supports an in-depth interpretation of
  fluorescence videos by creating objective
  evaluation of results visually and in color
• BLUE 400 Fluorescence-guided tumor resection
• Visible differences
• Excellent aid for visualizing tumors clearly at
  any time during the procedure

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AMIGOs MicroscopeZeiss OPMI Pentero

• State of the art apochromatic optics
• Crystal-clear images, sharp details, natural
  colors
• Variskop provides a larger working range and
  comfortable conditions
• 17 field depth increase
• Convenience
• Ergonomically correct design for cranial, spinal
  and posterior fossa procedures
• Surgeon can be standing or seated
• Design is 30 more compact
• Allows for freedom of hand and instrument
  movement, short distance to surgical field
• Overhead design
• Suspension system can be placed in any position
  (even behind surgeon)
• Several different configurations available
• Stereo co-observation tube remains in same
  position as microscope is repositioned
• Light
• 20 more light for surgeons (more for assistants)
• Spot illumination
• Precisely adjusts light cone without reflections
• Two-channel illumination system
• Higher-contrast images in narrow and deep canals

• Integrated digital visualization immediately
  produce and process digital video
• Simply Unique (user-friendly solutions for OR
  staff)
• AutoBalance one-touch button
• AutoDrape air evacuation to precisely fit
  sterilization drape over microscope
• FlexiTrak easy transportation
• Superlux 330 easy to change lamps and modules
• Workflow Integration
• Fast and easy connection to all leading
  navigation systems without external components
  and wiring
• Open interface system
• Use same workstation and cable with other ZEISS
  surgical microscopes
• Binocular, color injection and superimposition of
  navigation data
• Robotic X/Y design with three motorized axes
• Provides real tool tracking for viewing every
  point in working and tilting range of OPMI
• Laser-guided, high-speed autofocus system
• Delivers precise navigation by focusing to a
  fraction of a millimeter
• Precisely identifies displayed point
• MultiVision
• Enables surgeon to inject information and data
  into the eyepiece
• Touchscreen interface can be injected into
  MultiVision display and controlled using the
  joystick

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AMIGOs MicroscopeZeiss OPMI Pentero

• FDA cleared for any MRI-guided intervention on
  MRI scanners
• Clinical procedures on open scanners
• Prostate brachytherapy and cryotherapy, RF
  ablation of liver tumors, cryotherapy of renal
  cancer, breast biopsy, brain surgery
• Research on close-bore scanners
• MRI catheterization and endoscopy, motion
  artifact elimination
• Clinical Applications
• Many MR-guided diagnostic and therapeutic
  procedures
• Biopsy and aspiration (breast, brain, liver,
  prostate).
• Tumor RF/laser ablation (liver).
• Brachytherapy (prostate, kidney).
• Image-guided neurosurgery.
• Pain management (nerve blockage).

• Specifications
• Realtime 6 degrees-of-freedom tracking during MR
  imaging with FSE, FGRE, SPGR, SSFSE.
• Number of Tracking Devices 2 out of 4 ports.
• Tracking Accuracy Location 2mm, Orientation 1
  degree (values represent 2 standard deviations of
  the tracking error population).
• Tracking Range Up to 30cm from the center of the
  scanner.
• Tracking Angle Unlimited (360 degrees).
• Tracking Rate Up to 16Hz.
• Input Power 120VAC/0.8A (60Hz) or 230VAC/0.4A
  (50Hz).
• Comes with a set of mechanical tools that help
  the physician navigate a needle to a specific
  location inside the patient
• Sensors
• Acquires the location and orientation of a sensor
  during an MRI scan
• Sensor is a 3 dimensional magnetic field sensor
  made by 3 orthogonal pick up coils
• Comes in different sizes and shapes, to fit the
  specific application
• Most popular
• Basic cube sensor for hand held guided tool
• Micro sensor with about 1.5 mm diameter for small
  tools, catheters and more

41
To be continued