Image-guided therapy, a central concept of 21st century medicine, is the use of any form of medical imaging to plan, perform, and evaluate surgical procedures and therapeutic interventions. Image-guided therapy techniques help to make surgeries less invasive and more precise, which can lead to shorter hospital stays and fewer repeated procedures.
While the number of specific procedures that use image-guidance is growing, these procedures comprise two general categories: traditional surgeries that become more precise through the use of imaging and newer procedures that use imaging and special instruments to treat conditions of internal organs and tissues without a surgical incision.
The cross-sectional digital imaging modalities Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are the most commonly used modalities of image-guided therapy. These procedures are also supported by ultrasound, angiography, surgical navigation equipment, tracking tools, and integration software.
History of Image-guided Therapy at BWH
With almost 30 years of innovation in the field of image-guided therapy (IGT), Brigham and Women’s IGT team is recognized as the leader in introducing these novel techniques into the treatment of complex cases.
Radiologist and former co-Director of the AMIGO suite Ferenc A. Jolesz, MD, established the Image-Guided Therapy Program at BWH in the early 90s. With training in both radiology and neurology, Dr. Jolesz had been envisioning ways that neurological conditions could benefit from the types of targeted, precise treatments that image-guidance provides. The challenge was to develop the imaging systems that could support these types of techniques.
Dr. Jolesz began collaborating with a team of engineers from GE Healthcare in 1988 to build the first MRI scanner for use during surgical procedures. The system had two magnets on each side of a patient table, giving surgeons access to the patient who remained situated in the MRI scanner.
Dr. Jolesz and the Brigham and Women’s IGT team soon followed the successful development of intraoperative MRI with another landmark achievement. In 2004, the Food and Drug Administration approved the first image-guided procedure: MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. Developed by BWH’s IGT team, this non-invasive interventional procedure uses MRI to monitor and control high intensity ultrasound waves that are beamed onto a fibroid and destroy it with heat. Specialists have since used the technique to treat breast and brain tumors and relieve pain from bone metastasis.
BWH’s image-guided therapy program continued to lead the advancement of the field into the 21st century, accumulating vast knowledge on best practices in designing and implementing image-guidance systems, establishing clinical programs, and designing IGT research studies. This cumulative body of work drew the attention of the National Institutes of Health, which selected Brigham and Women’s Hospital to become the National Center for Image-Guided Therapy (NCIGT) in 2005.