Patient receiving care from three practitioners in the hybrid procedural suite

ROCHESTER,
Minn. — Looking to the future, radiologists at Mayo Clinic in Rochester saw an
opportunity to bring several disparate tools together into a unified space to serve
complementary roles in sophisticated, minimally invasive cancer treatments.

The
Hybrid Procedural Suite was designed primarily to advance the evolving practice
of tumor ablation — a needle-based treatment that destroys cancerous or
otherwise abnormal tissue.  Ablation is
used to target cancer in locations such as the kidneys, liver, lung and
prostate, as well as soft tissues and bones. The Hybrid Procedural Suite brings
together CT, fluoroscopy and ultrasound in one room,
with MRI procedural capabilities
in an adjoining room. In the near future, a third room will be constructed to
add a dual-source CT scanner.

“The
driving force is really to improve outcomes for patients,” says Matthew Callstrom,
M.D., Ph.D.
,
chair of the Midwest Department of Radiology, adding that combining these
technologies will allow for more objective measurement of the success of these
procedures, and provide opportunities for the approach to be standardized and
improved.

“Right
now, I’d say the world operates along the lines of using tools that are
not designed specifically for use in ablation. You
find workarounds and try to do the best you can with the tools that you have,” Dr. Callstrom says. “We need
a standard approach to treatment and to drive toward very predictable outcomes.”

Procedural suites are
nothing new. The hybrid piece is, though — specifically bringing fluoroscopy
into the CT suite and allowing for these tools to be combined with MRI, Dr.
Callstrom says. “This sort of integrated solution is only offered in a few
centers across the world. The way we’re trying to do it is unique, with a full
solution-based strategy. The ultimate goal is to drive patient outcomes so that
the treatment they get at Mayo Clinic is better than anywhere in the world.”

As
part of the collaboration to build this new suite, the Department of Radiology
worked closely with anesthesiologists, urologists, medical oncologists, neurologists,
neurosurgeons, orthopedic surgeons, radiation oncologists, physicists and
outside experts to develop solutions that would help physicians perform each
complex procedure, and plan for and assess progress during and after the procedure.

“We’ve designed a
room with CT and fluoroscopy together, which allows us to, for example, place
devices off axis in the spine or pelvis because those structures are not
aligned in the axial plane,” he says. “Also, if monitoring a procedure
with MRI is the best approach, we’ve worked with Philips to develop a transfer
system to go from CT into the MRI suite because those two rooms are adjacent
and separated by a door. The barriers to using the right imaging modality at
the right phase of treatment have been markedly reduced.”

Another aspect that
distinguishes Mayo’s approach is that each room can be run independently with
unrelated procedures occurring simultaneously, Dr. Callstrom says.

“This
Hybrid Procedural Suite has been an important part of our conception of how we
take our practice to the next level,” says Anil Nicholas
Kurup, M.D.
,
an abdominal and interventional radiologist. “The suite serves as a platform
to really elevate the care of patients with complex cancers. We have taken off
the harness and removed any limitations we previously had regarding how best to
both visualize the target of our procedure, and apply the tools and the
techniques we typically use outside of procedures. Some steps are done well
with one type of imaging modality; whereas, other parts of these complex
procedures are done well with another imaging modality.”

To
help achieve the vision for what the suite would include, Dr. Callstrom says
that Mayo Clinic collaborated with Philips to tailor the equipment needs so
that the radiology staff could perform these important procedures without
interruption.

“Part
of the collaboration with Philips was to take a look at solutions rather than
just the procedural event,” he says. “Can we plan effectively? Can we
come up with an approach where we figure out what the thermal dose is, drive
toward a specific dose, assess it afterward, and measure very accurately and
objectively what the ablation margin is? None of these tools exist currently,
so we’re collaborating to develop new solutions.”

The
unification of the tools will allow for improved outcomes through precise,
individualized medicine, Dr. Callstrom adds.

David Woodrum,
M.D., Ph.D.
,
an interventional radiologist, says Mayo Clinic physicians have used each
modality — CT, MRI, fluoroscopy and ultrasound — individually for various
procedures, but integration was needed to take patient care to another level.

“We
need to couple the modalities together to bring out the best qualities of each,
and then use that combination to bring new treatments for patients where there
aren’t treatments now,” he says, adding that this space specifically
improves options for patients in need of spine and pelvic interventions, and
prostate and liver cancer therapies.

“I
think the benefit of this new suite for patients is twofold: No. 1, creating
procedures that were not possible before. Some of the prostate cancer
recurrences we’re treating really have had surgery, have had radiation, but
just don’t have any other options. So image-guided ablation gives them another
treatment option,” Dr. Woodrum says. “This is also true for some of
the vascular malformations that we’re treating in MRI. Many of these patients
have exhausted standard surgical or medical therapies, and are really left
without much hope. So if we can offer another treatment possibility due to more
detailed imaging, then this gives our patients hope where there was none. No.
2, we need to deliver the most precise treatments we can possibly deliver. And
by using each imaging platform in its most advantageous way, we can deliver the
best results to the patient.”

It’s a learning process, moving to the new suite, Dr. Kurup says. “Teamwork was better than I could have hoped for, really, and it’s ongoing. The innovation behind the Hybrid Procedural Suite is not just limited to the construction of the space, but is a mindset that our team carries forward each day.”  

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