Looking Good

A new mobile CT scanner is revolutionizing cranial and spinal procedures at Cape Fear Valley. It offers surgeons diagnostic-quality CT images of their patients’ brains and spines during surgery in the operating room. The innovative Airo TruCT scanner provides real-time, high-resolution images and helps surgical navigation software pinpoint exact locations within the brain and spine within one millimeter of accuracy.  “The sophistication of what we have at Cape Fear Valley is at the next level. We can see exactly where we are during surgery, we know exactly where we are in their brain. The accuracy is outstanding,” said Charles Haworth, MD, Director of Neurosurgery at Cape Fear Valley. Haworth says this newly acquired medical tool allows for 32 slice CT images to be taken of the entire spine in only 40 seconds. The CT scanner is able to scan soft tissue, like the brain, and not just bone anatomy, during surgery. The information gained facilitates minimally invasive surgery, advances quality control and provides real-time updates to improve patient outcomes. One benefit to the Airo TruCT scanner is its accuracy to assist as a navigational tool. “This CT scanner identifies our location within one millimeter of accuracy. It gives us the exact location and helps you go the shortest distance possible to get to the area needing attention,” said Haworth. “We know where everything is so we can avoid structures we don’t want to injure, like blood vessels. We navigate through delicate structures. This helps avoid nerve or brain injury, which has been a huge revolution in neurosurgery. Over the time I’ve been in practice, using a brain or spine navigation system has become the standard of care.” The Airo TruCT scanner works with a computerized navigation system to provide accurate three-dimensional images of the brain and spine, which in turn provides precise information on the operating table during surgery. “We’ve been using a very robust, advanced navigation program since I got here nine years ago, but the new upgrade enables us to see in the brain in real-time,” he said. “We can see better. It’s better visualization. We could not image the brain during surgery before now.” Another benefit of real-time CT images during procedures is for the surgeon to immediately be able to evaluate issues like the size of a blood clot in the brain, or a shift to the spine after placement of a graft. “Let’s say we have a blood clot in the brain. We can take a CT in the emergency room, but by the time you get to the operating room, the clot might have gotten bigger. We would not know that if we relied just on the first scan, but if we scan on the operating table, we can see exactly the way the brain looks at that time. It allows us to go straight to it and take it out. We can also rescan to make sure that the patient did not rebleed, before going to the recovery room,” said Haworth. The Airo TruCT scanner also can help the surgeon adjust for slight movements during surgery. "When working on the spine, the orientation of the spine can change during surgery. The old image might not be accurate because the position of the spine on the table has changed. With this CT scanner, you can get another scan. It gives you feedback and updates on what you are doing,” said Haworth. According to Haworth, repetitive plain X-rays or fluoroscopy used to be the standard for spinal surgeries but using the CT scanner sparingly throughout procedures also reduces the risk of radiation for patients, surgeons and operating room staff. “We might not shoot a second scan until the very end of the case. The CT scans are more accurate, and we can scan up to one meter of the body, including the entire spine while operating,” said Haworth. Further, a large benefit to the intraoperative scanner is the ability of the surgeon and operating staff to verify that the surgery was successful before the procedure is completed. “We don’t have to bring the patient from the operating room to another room for a CT scan and bring them back to the operating room for the process again if we see something. It’s in the operating room with us and we can scan the patient on the operating table. This is extremely efficient, safe and better- quality care,” said Haworth. The real-time updates from the portable CT scanner also provide confidence to Haworth and his associate Dr. Prithvi Narayan that they have completed the surgery at that time with immediate and verifiable results.

“The sophistication of what we have at

Cape Fear Valley is at the next level. We can

see exactly where we are during surgery...

The accuracy is outstanding.”

“If a tumor was being removed during surgery, we can check with real-time images to make sure the entire tumor is removed. This also applies to making sure tiny screws are in the correct place in the spine or a catheter is placed correctly in the brain to help drain fluid. The ability to rescan the patient enables immediate quality control,” said Haworth. “We can rescan the patient and check to make sure everything has been done properly. This is my standard of care. To make sure everything is perfect before the patient leaves the operating room. It’s a quality check device.” In a field where surgery needs to be precise, the Airo TruCT scanner is helping surgical hands navigate with the most advanced technology for the benefit of their patients. Cape Fear Valley is one of the few hospitals in North Carolina with the latest upgrade in this equipment.