• By Ethan Grove

Mayo Clinic radiologists take procedural practice into the future

December 2, 2019
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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