gms | German Medical Science

Objective: Over the last two decades the use of intraoperative magnetic resonance imaging (ioMRI) has developed in the field of neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potential hazardous environment for intubated patients. Therefore, strict safety guidelines in the operating room (OR) are necessary. The use of standardized checklists can minimize errors while increasing efficiency and improving workflow.

Methods: The Zurich checklist for transcranial or transsphenoidal surgery in the 2-room high-field 3 Tesla ioMRI suite (Siemens 3T Skyra VD13 with a NORAS MRI Products intraoperative 8-channel head coil) is described. We summarize its concept and the experience gained from over 300 surgical procedures using this new system within a 4-year period.

Results: Particularities of the 2-room setting used at our institution can be summarized as 1) patient transfer from a sterile to a non-sterile environment and 2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the magnetic field strength or sterility concerns. Each step of the checklist corresponds to specific phases and actions taken during the workflow in the ioMRI suite, ranging from the moment prior to draping until the transfer of the patient to the MRI room. Most steps are relevant to any 2-room ioMRI-OR suite and not specific to the system used in Zurich. The presentation will provide detailed images and video stills of important steps in ioMRI imaging and safety.

Conclusion: The use of an ioMRI-checklist promotes a zero tolerance policy for errors, can lower complications and help create an environment that is both efficient and safe for the patient and OR staff. We highly recommend the use of a surgical checklist when applying ioMRI technique.