Dr. Alexandra Golby, Director of Image-Guided Neurosurgery at BWH, is pictured with patient Brett Johnson.
In 2009, Brett Johnson was a healthy 47-year-old enjoying his life as a singer, teacher, and pianist when he began to suffer from nagging headaches.
As a precaution, his physician ordered an MRI (magnetic resonance imaging) scan of his brain. When the test revealed a cancerous tumor, Johnson recalls feeling shocked, then devastated. On a scale of I–IV, where IV is the most serious, the tumor ranked a Grade III. Johnson’s distress was compounded when he learned the tumor—called an oligodendroglioma—was located in an area of the brain associated with creativity and emotion.
“Creativity is my whole life and career,” Johnson says. “I thought, ‘Please, not that.’”
Within three weeks of his diagnosis, Johnson’s tumor was removed by neurosurgeon Alexandra Golby, MD, at Brigham and Women’s Hospital (BWH). After two months of oral chemotherapy and 33 sessions of radiation, physicians told Johnson that while some cancer cells would always be there, his cancer was stable.
“I was so grateful and happy to have my life back,” says Johnson, who resumed his career with no negative effects on his creative abilities.
Part of Johnson’s new routine meant having follow-up MRIs for the rest of his life. In 2012, something new appeared on a scan. Johnson’s care team could not tell if it was new tumor growth or scar tissue, so they recommended a second surgery.
A Vision for Image-Guided Procedures
In the three years between Johnson’s surgeries, BWH opened the Advanced Multimodality Image Guided Operating (AMIGO) suite, designed to guide complex treatments and procedures with navigation tools and imaging technologies including MRI, CT (computed tomography), PET (positron emission tomography), fluoroscopy, angiography, and ultrasound (see Radiology 101).
“Second only to my wedding day, my second surgery was the most profound day of my life,” Johnson says. “Dr. Golby explained that AMIGO would allow her to use imaging during surgery, which would help her be much more precise.”
“With the naked eye, a tumor looks nearly identical to the brain,” says Golby, BWH’s director of image-guided neurosurgery. “The most dangerous part is when you’re trying to remove the last 10 to 15 percent of the tumor, at the very edges. AMIGO gives us images during surgery, which helps us accomplish a more complete removal without damaging healthy tissue surrounding the tumor.”
The results of Johnson’s surgery in AMIGO were encouraging. Golby found scar tissue—no new cancer growth.
AMIGO was the brainchild of the late Ferenc Jolesz, MD, a BWH radiologist whose peers and students called him the father of modern day image-guided therapy. Since its opening in 2011, AMIGO has hosted more than 1,200 procedures for the brain, head, neck, spine, lungs, abdomen, and pelvis. The suite also doubles as a translational research lab and is the centerpiece of the National Center for Image Guided Therapy, funded by the U.S. National Institutes of Health, based at BWH, and led by Clare Tempany-Afdhal, MB, BAO, BCh.