The McConnell Brain Imaging Centre's software is like a GPS for the brain

In Canada, October is dedicated to brain tumour awareness. Brain tumours are a complex condition that affect an estimated 55,000 people across the country and is a life-long medical concern, whether malignant or benign. They are sometimes severe enough that they must be removed through surgery. To improve patient outcomes in these cases, the McConnell Brain Imaging Centre (BIC) is using software innovations.

Dr. Louis Collins is a professor of Neurology and Neurosurgery, and Biomedical Engineering at the BIC. He and his team have developed the Intra-operative Brain Imaging System (IBIS), a neuronavigation software that identifies structures and images of a patient’s brain anatomy. The IBIS software can dynamically account for changes that occur to a patient’s brain during surgery.

From left to right: Inez Jabalpurwala, Brain Canada; Dr. Philip Barker, Montreal Neurological Institute; Lili de Grandpré, Brain Canada; Dr. Guy Rouleau, Montreal Neurological Institute, Sylvain Vinet, CIBC ; Ian Gerald, CIBC – Brain Canada Fellow; Dr. Vincent Castellucci, Brain Canada; Dr. Louis Collins, Montreal Neurological Institute.
From left to right: Inez Jabalpurwala, Brain Canada; Dr. Philip Barker, Montreal Neurological Institute; Lili de Grandpré, Brain Canada; Dr. Guy Rouleau, Montreal Neurological Institute, Sylvain Vinet, CIBC ; Ian Gerald, CIBC – Brain Canada Fellow; Dr. Vincent Castellucci, Brain Canada; Dr. Louis Collins, Montreal Neurological Institute.

“Neurosurgery is very delicate,” says Dr. Collins. “You want to remove as much of the brain tumour as possible, but without harming the surrounding healthy tissue. Even a millimetre’s mistake can cause serious complications for a patient’s outcome.”

Dr. Collins likes to compare IBIS to a GPS system for the brain. “Existing imaging software acts like a paper roadmap: it can only tell you how to get to your destination, or in this case where to find the brain tumour. Like a GPS, our IBIS can warn for unforeseen difficulties like closed roads or traffic, or in the case of neurosurgery, difficulties like brain tissue that may have shifted since the start of the operation.”

Most brain imaging software can also only provide a pre-operative picture of a brain, but this offers only limited help for an ongoing surgery. “Once the surgery has started, the brain has a tendency to swell,” explains Dr. Collins. “An anaesthesiologist can correct this swelling with medication, but there will still be distortions between the pre-operative images and the configuration of the brain the neurosurgeon is operating on.”

The IBIS software works with an ultrasound scanner to image the patient's brain during surgery, so that it can align the pre-operating data brain map with the actual brain during surgery. So even if the brain swells during an operation, the brain tumour can be located accurately and this reduces the risk of harming healthy tissue.

Improvements to IBIS are being made every day. “The first iteration was accurate, but very slow. It took the computer ten minutes to analyse the data from the ultrasound and realign the new brain image with the pre-operative one,” says Dr. Collins. Today, IBIS is able to reduce the response time to about ten seconds, which gives neurosurgeons at the McGill University Health Centre information much more quickly and ultimately contributes to better patient outcomes. “We think this technology will ultimately change the surgical paradigm, from imaging once preoperatively to repeated imaging during surgery.”