OR Technology Saves Time, Reduces Risk

Star Tribune (Minneapolis)

March 25, 2014

Jay D. Miller looked down over the copper-sheathed surgical suites being built at IMRIS Inc.'s Minnetonka headquarters and dared to dream.

He dreams of a day when his company's technology that allows surgeons to take detailed MRIs and CT scans of patients during surgery will be in many more hospitals worldwide. At a cost of $3.5 million to $7.5 million just to install the company's interoperative MRI (iMRI) scanners, he understands it will take some time.

"It's a significant capital expenditure," said Miller, who has been at the helm of the company since July. "But high-volume neurosurgery hospitals, especially children's hospitals touting pediatric oncology, are going to want our technology. If you can catch a brain tumor soon enough in a kid and completely remove it, the outlook is fantastic."

That, in a nutshell, is what IMRIS and its 130-plus employees are selling - high-tech operating rooms featuring giant, ceiling mounted high resolution scanners that show images to the surgeon while the patient is on the operating table. Miller said that allows surgeons to go immediately back into a patient's brain or spine for anything they missed without another operation.

Last month, the U.S. Food and Drug Administration approved IMRIS' newest generation surgical suite—the Visius Surgical Theatre—that incorporates magnetic resonance imaging, CT and fluoroscopy into a connected set of rooms. The scanners move between the operating rooms on overhead tracks and have been used on more than the 13,000 patients.

Saving time, reducing risk

The company is also working to develop MRI-compatible surgical robots that will one day allow surgeons to operate while the MRI is actually being taken to make the procedure even more precise, Miller said.

"There will literally be no lag time between when the image is taken and when the surgeon removes the tumor," he said.

The idea is to save time, save additional surgical procedures and improve patient safety and outcomes. Instead of a patient getting an MRI days before surgery, then another days later—only to discover that a bit of tumor remains—the IMRIS system means doctors can see what they missed and go back to work without the patient or surgeon leaving the operating room.

In 40% of cases involving IMRIS technology the surgeon discovered more work needed to be done after the initial surgery, Miller said. In 55% of tumor removal cases, the surgeon removed additional tumor after an interoperative MRI. And according to IMRIS, the technology allowed the surgeon to remove the total tumor in 86% of cases—vs. 55% without an iMRI.

Hospitals that have installed the technology include the Cleveland Clinic, Johns Hopkins in Baltimore, the Mayo Clinic in Jacksonville, FL, and Duke Medical Center in Durham, NC. Abbott Northwestern Hospital in Minneapolis and United Hospital in St. Paul were among the first U.S. health centers to install IMRIS' technology, in 2007. Each hospital has performed close to 1,000 procedures using the IMRIS technology.

Helpful, but is it necessary?

"It's wonderful," said Dr. Mahmoud Nagib, a neurosurgeon who has done most of the cases performed at Abbott Northwestern. "At times, you have to do more than one scan, to make sure you get the complete tumor. I have done up to four scans during the surgery, before closing the exposure."

He added: "The advantage is one anesthesia, not two anesthesias. You can identify if there is a complication. You know right away. With brain issues, time is of the essence."

Last week, Nagib performed brain surgery on an 18-month-old baby and a 40-year-old adult, both using the IMRIS surgical suite. In other cases, he said, the IMRIS scanners caught hemorrhages that occurred during surgery and have spotted tumors or bits of tumor not seen in the first exposure.

"I believe in the value of this system," he said. "Years ago, a doctor would say, 'I think I got 99% of this tumor.' But, days later, another scan would find more after the patient has been sewed up. Essentially, this saves the patient another operation."

Dr. Eric S. Nussbaum, director of the neurovascular neurosurgery program at United Hospital, also has used the IMRIS technology seven or eight times in the past eight months. But while he said it's a good and useful technology in some cases, it is not necessary for the majority of brain surgeries, including tumors.

There are cases where the expensive technology can be especially helpful, he said, such as with tumors that look a lot like normal brain tissue. It can also help in operations where scar tissue makes it difficult to differentiate tumors from healthy tissue. But in many cases, he said, "a good surgeon will know they have completely removed the tumor and should not be bleeding afterward."

Profits and losses

IMRIS went public in 2005 and completed its move to Minnesota from Winnipeg in 2013. The company has installed systems in 28 hospitals in the United States, with installation pending in 10 more. Outside the United States, 13 hospitals have installed the technology and four are pending.

Still, the company is not yet profitable.

According to IMRIS' most recent financial report, delivered March 4, fourth-quarter 2013 revenue was $10 million, compared with $20.1 million for the same quarter the year before. The company reported a net loss of $21.6 million for the quarter. Full year 2013 revenues were $46 million, compared with $52.4 million in prior year. It reported a net loss in 2013 of $42 million.

In the 2013 annual report, Miller said the company's broader range of products will help build momentum in 2014. Key to that, he acknowledged in an interview, is building the number of hospitals installing IMRIS technology. The company now is working to gather cost-effectiveness data to help make its case to other hospitals.

"This saves time and it saves procedures," Miller said of IMRIS' surgical suite technology. "Hospitals want to know when that patient goes home that they have done the very best they can for that patient."

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