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In Image-Guided Operating Suites, Surgeons See Real-Time MRI, CT Scans

Rating

2 Star

In Image-Guided Operating Suites, Surgeons See Real-Time MRI, CT Scans

Our Review Summary

The story provides an overview of techniques that incorporate computerized tomography (CT) scans and/or magnetic resonance imaging (MRI) into surgeries, giving surgeons “real-time” images of the patient and what is happening during the procedure. The idea is that such real-time imaging makes the surgeries more accurate and reduces the likelihood of repeated surgeries or complications. Though it quotes an expert who says the new technology allows surgeons to perform “significantly better” than with conventional surgery, the story never backs up that assertion. It offers very little information on whether these techniques are actually resulting in better health outcomes for patients or how far these techniques are from widespread adoption.

 

Why This Matters

The story notes that these real-time imaging techniques are primarily being considered for use in brain and spinal surgeries and for a number of surgeries related to biopsy and tumor removal. These are surgeries that often pose considerable risks for patients. Even small mistakes can have significant long-term effects on a patient’s quality of life. Patients and doctors who are dealing with these kinds of surgical decisions are likely to be very interested in new techniques that could improve surgical outcomes. However, the story does not offer much quantifiable information that can be used to help guide decision making.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story notes that the technology needed to implement these real-time imaging techniques is costly for hospitals, and lists examples of technologies that range in price from $1.5 million to $7 million. The story could have done even better if it had placed those numbers in context. How much does it normally cost to outfit a surgical suite? And what do these costs mean for patients? It would have been hugely helpful to compare costs for the same surgery with or without the new technology. On a related note: are insurers covering the costs of these real-time imaging procedures?

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story focuses on how these new techniques and technologies can address perceived shortcomings in conventional surgery. And it uses compelling language to describe these potential benefits: “The resulting real-time 3D visuals—known as ‘intraoperative imaging’—help surgeons excise tumors and tissue with greater accuracy, reducing risks, such as nicked nerves from an errant knife, and the potential need for repeat surgery. The images also help surgeons spot bleeding, blood clots or other unexpected complications outside their field of vision.”

However, the story doesn’t offer any numbers to demonstrate whether that potential is being fulfilled. For example, the story notes that the Advanced Multimodality Image-Guided Operating Suite program at Brigham and Women’s Hospital, which focuses on these real-time imaging techniques, has conducted 700 surgeries since 2011. Did those surgeries have better outcomes than comparable surgeries that didn’t use these imaging technique? The story doesn’t say.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

This one’s a close call that we ultimately ruled unsatisfactory. The story is enamored with the greater accuracy that “real-time” imaging should provide for surgeons, but it doesn’t acknowledge that the scalpel cuts both ways. With increased visibility, there’s a greater chance that these scans will turn up so-called “incidental findings” — problems that no one was looking for and that could well be meaningless to the patient (for example, a slow-growing tumor that would never pose a real risk to the patient). Cutting based on such findings may, in fact, increase morbidity and mortality.

The story does get credit for thoroughly explaining the potential risks associated with MRIs. However, the story does not address the risks associated with CT scans at all. CT scans require exposure to a significant amount of radiation, and patients can suffer allergic allergic reactions to the contrast dyes.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The only quantifiable evidence the story presents is that “in 40% of cases, brain surgeons will modify what they are doing based on an intraoperative MRI scan.” However, it’s not clear where that number comes from, making it difficult to assess the quality of the evidence. Moreover, surgeons modifying what they are doing does not mean that the patient’s outcome is necessarily going to be better. Otherwise, the story relies on one lengthy anecdote and qualitative discussions of why these real-time imaging techniques make sense. Some analysis of the existing literature on these techniques would have been valuable.

Does the story commit disease-mongering?

Satisfactory

We’ll rate this satisfactory for a lack of any obvious disease mongering. But as noted above under “Harms,” there is a presumption in this story that increased access to imaging can only be a good thing. The story doesn’t entertain the possibility that these scans will turn up meaningless — but potentially worrisome — findings that could cause anxiety for patients and lead to overtreatment.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The two doctors quoted in the story on the value of these real-time imaging surgical techniques are both leaders of high-profile programs that are dedicated to, well, advancing these real-time imaging surgical techniques. The story would have benefited from the input of an independent source.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story explains how, in theory, real-time imaging could significantly improve surgical outcomes. But the story does not actually offer any comparison of the outcomes of surgical procedures that use real-time imaging techniques versus surgical procedures that do not.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The story discusses the relatively new Center for Surgical Innovation in New Hampshire and the program at Brigham and Women’s Hospital in Boston. But it’s not clear from the story whether these real-time imaging surgical techniques are being implemented elsewhere. Is it widespread? Do we expect it to become widespread? If so, when? And at what cost?

Does the story establish the true novelty of the approach?

Satisfactory

The story clearly notes that these techniques were originally developed for use in brain surgeries, but are now being considered for use in a variety of other procedures — and have been since at least 2011.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to draw from a news release.

Total Score: 4 of 10 Satisfactory

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