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existing workflows, like the use of syngo iGuide in trauma, reducing radiation exposure for everyone on the team. Hopefully we can prove that 3D imaging combined with navigation can reasonably reduce radiation dose to one twentieth of what it used to be.“ The biggest success for Prof. Gebhard is the proof of principle for combining the imaging and navigation systems in orthopedic trauma surgery. “We were the first to prove that it works,“ stated Prof. Gebhard. Up until now images gained outside the OR could not be used intraoperatively for navigation purposes. An example is for tumor resections. Now, they can even be generated in the OR itself. “Being able to perform image fusion in the OR, or using intraoperative syngo DynaCT saves considerable planning and preparation time, and helps with adhering to preoperatively defined resection margins,“ explained Dr. Richter. Prof. Gebhard and his team use the hybrid room for complex spinal and pelvic fractures, especially for navigated stabilization of the spine and for oncologic bone surgery. The Artis zeego provides them with more confidence due to the higher image quality, larger field of view, and greater heat loading than older style image intensifier imaging. “There is a huge benefit for minimally displaced fractures of the pelvis, for the obese, and for elderly patients,“ concluded Prof. Gebhard. Neurosurgical Frontiers As for the neurosurgeons the new angio-based hybrid lab also opened up new prospects, even though Dr. Wirtz already had long-standing experience with intraoperative imaging in neurosurgery when he came to Ulm five years ago. He is one of the pioneers of intraoperative MRI in neurosurgery. “While I was at Heidelberg University we were the first department worldwide to use intraoperative MRI in a brain tumor resection.“ With an MRIbased hybrid OR in Günzburg and more than 600 cases with MRI by now, Dr. Wirtz and Ralph König, MD, Assistant Director of Neurosurgery in Ulm, were interested in an angiobased hybrid room for aneurysm cases, above all. “Aneurysm clips create artifacts in MR imaging, which in turn make it difficult to evaluate the patency of the vessel,” states Dr. König. „Plus, one feels more secure in using angio during sophisticated neurovascular interventions. It is very useful to have high quality DSA imaging after microsurgical excision of an AVM, in order to detect residual nidus, which would increase the patients’ risk of hemorrhage.” One new area of interest for the neurosurgeons One new area of interest for the neurosurgeons is 3D imaging with an intravenous contrast injection. A ten second syngo DynaCT spin with 80 cc of full strength contrast and viewing with 15 mm MIP slices is the current technique. Special Needs in Cardiovascular Cases For Dr. Bauernschmitt, who only joined the common journey this April, the situation is a little different from his neurovascular and orthopedic counterparts. He brings more than ten years of experience in hybrid OR from his time as Deputy Director at the German Heart Center, Munich. His expertise is in innovative catheter heart valve procedures like TAVI and mitral valve repair. He and Prof. Andreas Liebold, MD, Director of Cardiovascular and Thoracic Surgery, see the hybrid OR in their field as a must-have. Prof. Liebold, who became the Director of this Department in 2011 and was Deputy Director at the University of Rostock, is now responsible for the hybrid OR. The team of cardiac surgeons brings the most experience to this OR. As the cardiac surgeon in the Ulm multidisciplinary hybrid room, his challenge comes from the motion of the organ he deals with. “Cardiac and vascular surgeons work on soft tissues with inherent organ movement, as opposed to relatively fixed structures in trauma and neurosurgery. One could say that repairing a structure like an aortic valve is like tying a shoelace while running. Therefore, we have slightly different needs in the hybrid OR.” When asked about software, Dr. Bauernschmitt’s opinion is that syngo Aortic ValveGuide Orthopedic Trauma Surgery Surgery would be of great benefit to sites training in aortic valve implantation and for the new generations of anatomical valves. He is most interested in impending technical imaging advances for mitral valve repair. Future Perspectives If asked about the future, the physicians agree that they can see a time when expansion would be desirable and all would choose to construct a multidisciplinary hybrid lab again. Dr. Bauernschmitt’s recommendation would be that “disciplines working with soft tissue like cardiac surgeons and abdominal surgeons would share one OR, while the other OR could be shared by orthopedic surgeons and neurosurgeons working on or around bones.” For now, the Ulm hybrid room team will expand by training more staff and extending the hybrid room hours. Read more about multidisciplinary use of a hybrid room in following chapters. Medical writer Dr. Wiebke Kathmann is a frequent contributor to medical magazines for physicians of Germanspeaking media. She holds a MA in Biology and a PhD in Theoretical Medicine and worked as an editor for many years before going freelance in 1999. She is based in Munich and Karlsruhe, Germany. Contact penelope.vos@siemens.com AXIOM Innovations | December 2013 | www.siemens.com/angiography  65


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