Dr. Garnette Sutherland is a gifted neurosurgeon, often called upon by academic medical centres to perform difficult brain aneurysm surgeries that no other surgeon will do.

But he and other surgeons that operate inside people's brains were confronting a serious challenge — how to ensure they "honoured their contract" with their patients by doing a successful surgery.

The invention of CT- (computerized tomography) scanning technology in the 1970s, followed by the development of MR (magnetic resonance) imaging, allowed neurosurgeons to obtain high-quality images of a patient's brain, Dr. Sutherland explains. "Surgeons were then provided the opportunity to look inside the body and precisely know where that problem was that they were going to treat, either surgically or medically." However, this also meant that the surgical openings in a patient's head — the surgeon's physical 'window' into the brain — became ever smaller, as did the surgical tools.

To ensure surgery was successful, neurosurgeons came to rely on checking images of the patient taken following the surgery — for example, to see if a brain tumour had been completely removed. When surgeons see these post-operative images, they often wish they could do the procedure again in some patients, Dr. Sutherland says. In fact, in operations where a tumour hasn't been entirely removed or there's a serious post-operative complication, another surgery is a medical necessity.

Dr. Sutherland's envisioned eliminating the need for this "re-do" surgery. In collaboration with the National Research Council of Canada's Institute for Biodiagnostics in Winnipeg, Man., and with industry, he developed the Intraoperative MR System. This technology provides surgeons with high-quality MR images during an operation, so they can check their surgery before stitching up the patient.

"The innovation was to put diagnostic imaging in the operating room, in such a way that it does not affect how surgery is performed or interfere with the nursing or anesthesia," Dr. Sutherland says. The key to developing the Intraoperative MR System was to suspend the magnetic resonance imaging machine, (including a magnet weighing five tonnes) from a rail on the ceiling. This rail, based on proven overhead-crane technology, makes the MR machine movable and more cost-effective for hospitals and other institutions, Dr. Sutherland notes. "When the surgeon's not using it in the operating theatre, the machine can be moved to another room and radiologists can use it for diagnosing patients."

The current commercial version of the Intraoperative MR System uses a powerful MR machine with a high magnetic field strength, 1.5-Tesla magnet — the global standard for diagnostic imaging. This means the machine produces the exquisitely detailed, 3-D images required for delicate surgery.

The bore or hole of the magnet is very large, to accommodate specially designed, non-magnetic clamps that hold a patient's head still. Integral to the operation of the entire system was a hydraulically controlled operating table made of non-magnetic titanium that smoothly positioned the patient for the operation in a way in which the surgeon was accustomed.

Once the full system had been developed, Dr. Sutherland was ready for his first "patient."

On Jan. 6, 1996, he used the world's first Intraoperative MR System, built at the NRC's Institute of Biodiagnostics, to successfully remove a brain tumor from Kayla, a 6-year-old Shepard-cross dog.

The success of this first operation resulted in the fast-track construction by Magnex Scientific in the U.K. of the first clinical system, employing a powerful 1.5 Tesla magnet. U.K.-based Surrey Medical Imaging Systems Ltd. (since bought by Phillips) donated the electronics.

The Government of Alberta provided funding for a new building, next to the main operating rooms at the Foothills Medical Centre in Calgary, to house the world's first clinical Intraoperative MR System. Dr. Sutherland used it to perform the first operation on a human patient on Dec. 4, 1997.

Dr. Sutherland and his colleagues have since used the Intraoperative MR System at the Seaman Family MR Research Centre in Calgary to monitor surgery on more than 550 patients — and counting! However, developing the system — especially getting it accepted by the neurosurgical community — has been a challenge, he says. "Some people didn't think that we could actually build this magnet, put it on the ceiling, and move it in and out of the operating room."

It took Dr. Sutherland's dedication, together with colleagues Dr. John Saunders, David Hoult and Franklin Roberts, to make that vision a reality. All four hold the U.S. and International Patents on Surgical Procedure with Magnetic Resonance Imaging.

Funding support for the innovation came from the Canadian Foundation for Innovation, the Seaman family in Calgary, and the $50-million Partners in Health fundraising campaign led by Calgary businessman Harley Hotchkiss.

Dr. Saunders, who as a then-NRC scientist partnered with Dr. Sutherland to develop the MR component, is now President and CEO of Innovative Magnetic Resonance Imaging Systems Inc. (IMRIS) in Winnipeg. IMRIS, in partnership with Siemens, builds and sells the commercial iMotion Intraoperative MR system.

Led by Dr. Saunders, IMRIS has landed its first-ever sales of the US$2.5-million system. One unit is going to Children's Hospital Boston — Harvard Medical School's main pediatric teaching hospital — and the other unit to a general hospital in Wilkes-Barre in northern Pennsylvania. More sales in the U.S. are pending, and discussions have begun on potential sales in China, Singapore and Europe.

"Dr. Sutherland is truly a Renaissance man who has revolutionized neurosurgery and put Calgary, Alberta and Canada on the map in this area," says Dr Quentin Pittman, Past President of the Canadian Physiological Society and Professor of Physiology and Biophysics at the University of Calgary.

Dr. Sutherland has the dramatic images to prove it. Images of one patient, a five-year-old boy with a brain tumour, clearly show the tumour as an invasive white mass. And, just as clearly, MR images taken with the Intraoperative system during the operation show the tumour was completely removed.

The system has revealed unexpected problems or complications, such as residual pieces of a tumour, in about 20 per cent of patients, Dr. Sutherland says. In people who've had aneurysms, the images can show impending strokes in the brain, allowing the surgeon to adjust the treatment accordingly. "It bridges the gap between a pre-operative diagnostic image and a follow-up image."

Earlier this year, Dr. Sutherland received a $10.5-million award from the Canadian Foundation for Innovation to develop a MR-compatible surgical robot system called "neuroArm." This robotic system will allow a surgeon to control an operation inside the brain or other parts of the body from a computerized workstation — with 1,000 times greater precision than that of a human surgeon.

Winning the Manning Award of Distinction brings recognition, says Dr. Sutherland. "It's good for this project, and it's very good for people marketing the project and moving it forward."

This year, Manning Innovation Awards presents $145,000 in prize money distributed among four leading Canadian innovators, as well as $20,000 among eight Canada-Wide Science Fair winners. Since 1982, the Foundation has awarded over $3 million to recognize Canadian innovators.