Policlinico Gemelli IRCCS di Roma

Original article: Terapia chirurgica del Parkinson, al Gemelli utilizzate le tecnologie più avanzate a disposizione - Policlinico Universitario A. Gemelli IRCCS (policlinicogemelli.it)

From the neuronavigator, to the innovative stimulator, to the directional leads, to the software for verifying the positioning of the electrodes.

The most advanced (and most precise) instruments have been used 'completely' for the first time in Italy at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, for the Deep Brain Stimulation on a 52-year-old patient. The most avant-garde technological jewels for an ultra-precise, minimally invasive and patient-safe procedure.

Parkinsons milestone

A new milestone in the surgical treatment of Parkinson's has been reached at the Agostino Gemelli University Hospital Foundation. For the first time in Italy, Dr. Tommaso Tufo, a neurosurgeon at the Gemelli Polyclinic, implanted Percept PC™ with directional electrodes, the neurostimulator for Deep Brain Stimulation (DBS) therapy developed by Medtronic, using all the most advanced technologies currently available.

The surgery, carried out on a 52-year-old patient suffering from Parkinson's, represents a 'first' of its kind. For the first time, in fact, the latest Medtronic technologies have been exploited together: intraoperative imaging (O-arm), the Percept PC™ neurostimulator, with directional leads and, after implantation, the reconstruction of the positioning of the electrodes, with dedicated software.

"Deep Brain Stimulation (DBS) surgery - explains Dr. Tufo - is a technique that has long been validated (the first implant of this type carried out at Gemelli, which was also one of the first in Italy, dates back to 1996), which is indicated in movement disorders such as Parkinson's disease, essential tremor and dystonia, when medical therapy has not given optimal results or is burdened with important side effects.

This treatment is reserved for young patients, people under the age of 65, who respond little to medical therapy or who present disabling side effects from the same, such as on-off effects, motor fluctuations, blockages".

These interventions act on Parkinson's symptoms but do not cure it.

However, they allow to obtain a sort of 'rejuvenation' of the disease; for the patient, it is like going back to the early stages of his Parkinson's.

It's like being treated with an ideal 'H24' medication at a constant dosage.

The patient can expect an improvement in motor symptoms and it is possible to reduce drug therapy.

The response to this treatment also has good durability. "We have observed a good control of the symptoms of the disease - recalls Dr. Tufo - even in patients subjected to these implants twenty years ago, with neurostimulators certainly much less performing than those we use today".

DBS consists of the implantation of a neurostimulator, (a sort of pacemaker of the brain), composed of a generator that, like that of the cardiac pacemaker, is housed in a skin pocket under the collarbone, and a microelectrode that is placed at the level of the nuclei of the base, nerve structures that are located in the depths of the brain.

In order to realize this delicate implant in the brain, a very precise neurosurgical (stereotactic) technique is used.

"This technique in recent years has evolved - explains Dr. Tufo - thanks to the use of technologies and operating room instruments that allow you to be minimally invasive and ultra-precise. To 'centre' the implant area, it is used a 'neuronavigator' (a special operating room computer), which guides the neurosurgeon's hand on the cerebral 'roads', up to the nuclei of the base, following a sort of three-dimensional Google map, reconstructed starting from the images of the patient's brain MRI.

Thanks to the Intraoperative 3D Imaging system and the Medtronic Neuronavigator, the DBS procedure is performed with the fiducial-less technique, which avoids the use of the stereotactic helmet or bone screws, while ensuring maximum surgical precision and simplifying the flow of the procedure.

Computerized neuro-navigators are in turn connected to a kind of intraoperative CT scan ('O-arm') that allows you to check the position of the electrodes in real-time, directly in the operating room.

It is an important innovation; previously it was necessary, after the operation, to move the patient to radiology to carry out a post-operative control CT scan ".

After implanting the electrodes in the appropriate areas of the brain, the catheters that connect them to the pulse generator (a 'battery' of a few centimetres), housed in a subcutaneous pocket, under the collarbone, are passed subcutaneously.

Some of these generators are now rechargeable from the outside, can last up to 25 years and do not need to be replaced, as they once did.

The first DBS interventions were made in the early 90s; since then the technology has evolved very quickly, up to the current sophisticated systems.

"The electrodes used today – continues Dr. Tufo – are directional. They have various facets of stimulation, which allow directing the stimulation in a very precise way. Even the generators allow to carry out 'personalized' stimulations depending on the patient and the most advanced are able to read the brain activity (sensing), allowing to modulate the stimulation based on the patient's brain activity (so-called closed loop), thanks to dedicated software, which has just been released. All this also greatly reduces the risk of undesirable effects that are observed with classical stimulation (lowering of the timbre of the voice and effects on the production of language)".

"These new instruments, used for the first time all together here at the Gemelli University Hospital - underlines Professor Alessandro Olivi, director of the Gemelli Neurosurgery Unit, professor of Neurosurgery at the Catholic University - allow us to make this treatment more precise, effective and safe. It is the first time in Italy that the complete 'package' has been used, thanks to the commitment of the Gemelli Hospital Foundation which, responding to our request, wanted to invest in new technologies and personalized therapies".

Studies have shown that deep brain stimulation performed with the Medtronic DBS therapy system is effective in controlling essential tremor, dystonia and Parkinson's disease symptoms that are not adequately controlled by drug therapy. Medtronic DBS is also approved for the treatment of refractory epilepsy.

"The innovation of sensing – underlines Antonella Grassi, head of Medtronic's Neuromodulation division in Italy – represents an important contribution to the development of personalized therapies that can improve the quality of life for patients and in line with technological innovation. In addition, the accuracy of the measurements and the visualization programs connected to mobile devices and computers allow the doctor to verify in detail and with ease all the parameters he needs to set a tailor-made path ".

Information about DBS therapy by Medtronic

DBS therapy is currently approved in many countries around the world, including the United States and Europe, for the treatment of more or less recent-onset Parkinson's disease, essential tremor, primary dystonia, disabling symptoms of epilepsy and treatment-resistant obsessive-compulsive disorders.

Medtronic was the first company in the United States to offer full-body MRI conditional compatibility DBS systems to enable patients to undergo safe scans of any part of the body under certain conditions. Since 1987, more than 175,000 Medtronic DBS devices have been implanted worldwide for the treatment of motor disorders and other indications.

Original article: https://www.policlinicogemelli.it/news-eventi/al-gemelli-in-sala-operatoria-con-il-robot-hugo/

For the first time in Europe, at the Agostino Gemelli IRCCS University Hospital Foundation in Rome, a gynecological surgery was performed with Hugo, the new robot-assisted surgical system (RAS) developed by Medtronic, a leading company in HealthCare Technology. Professor Giovanni Scambia, Director of the University Department of Life Sciences and Public Health of the Catholic University and Scientific Director of the Polyclinic Foundation, carried out this first hystero-adnexectomy (removal of uterus and ovaries) on a 62-year-old woman.

prof. Giovanni Scambia
prof. Giovanni Scambia

"The one carried out today at the Gemelli Polyclinic Foundation - explains Professor Scambia - is the first gynecological surgery carried out in Europe with the new Hugo robot-assisted surgery system, a new robotic platform which, in addition to being the result of advanced and innovative technologies, has very competitive costs compared to the previous robotics. And this could finally launches this branch of surgery, born twenty years ago and still used in just 3% of all surgeries performed every year in the world. Having this new equipment available makes the Gemelli Polyclinic even more avant-garde at an international level. We plan to use the new Hugo robot-assisted surgery system, not only for benign gynecological pathologies of increasing complexity, but also for oncological pathology, gradually performing ever more complex and minimally invasive interventions ".

The 'historic' intervention

Lasting almost one hour, the first gynecological surgery performed in Europe with the Hugo robot-assisted surgery system is a prophylactic hysteroexectomy on a 62-year-old patient with a BRCA mutation (the so-called Angelina Jolie gene), which exposes at an increased risk of gynecological malignancies. The different phases of the intervention are the same used also in the case of an intervention of this type performed by the team of Professor Scambia in laparotomy or laparoscopy. It is therefore not the operating technique that adapts to the robot, but vice versa. The first step (starting on the left) is the resection of the round ligament of the uterus, which allows access to the retroperitoneal organs, in particular the ureter, to secure it. The uterine artery is then identified and closed with a surgical clip at its origin; then the influndibulum-pelvic ligament (which contains the vessels directed to the ovary) is identified and isolated from the ureter, then coagulated and sectioned. The operator then starts to work in the anterior compartment, where he detaches the vesico-uterine septum, to make the bladder slide down, away from the uterus; then they coagulate and dissect the uterine vein and artery at the level of the body of the uterus. These same operations are repeated on the right side. At this point, the uterus is isolated from all its 'hooks'. A circular incision is then made on the vagina with electrified scissors, right below the cervix; at this point the uterus, ovaries and tubes are extracted through the vagina. The surgery is completed by making a continuous stitch suture of the vaginal stump. (comment by Dr. Nicolò Bizzarri)

A new era in robotic surgery

The Hugo robot-assisted surgery system was created to make the benefits of robotic surgery available to more patients around the world, both in the gynecological and urological fields, which today represent about half of the interventions with robotic technology performed. This can happen thanks to the more sustainable costs and greater flexibility (it is a 'module' system that is well suited to all types of operations and operating rooms) this technology provides. In short: it is a 'democratic' robotic surgery system.

"The indissoluble link between technological evolution and clinical excellence - comments Engineer Giovanni Arcuri, Technical Department and Health Technology Innovation Department, Agostino Gemelli IRCCS University Hospital Foundation - represents the only possible way to guarantee patients state-of-the-art care. For this reason, the Gemelli Polyclinic continues to invest in technological solutions, with which our specialists can make treatment processes evolve, offering increasingly minimally invasive and effective surgical interventions. The Hugo robot-assisted surgery system is an innovative and technologically very advanced platform that is set to become a reference for the surgery of the future, also thanks to operating costs that make its adoption sustainable. Our goal as a Polyclinic is to combine clinical and technological excellence with economic sustainability, in the awareness that innovation represents an added value, only when it makes the benefits accessible to all patients. "

To robotic surgery school

Another advantage of the Hugo RAS system is that it has a fast training learning curve. Medtronic also takes care of training, which consists on a theoretical-practical course in the presence, in specialized environments, such as the Orsi Academy in Ghent (Belgium). After the theoretical-practical course, surgeons experienced in the use of the Hugo robot-assisted surgery system (so-called proctors) work alongside the 'trainee' surgeons in the execution of the first operations as supervisors in the operating room. The Gemelli Polyclinic Foundation will in the future make an important contribution to clinical development, training of new surgeons, and the progressive expansion of the type and number of operations in which to use it. The Gemelli thus joins a group of pioneering institutions, among the first in Europe to participate in Medtronic's "Partners in Possibility" program and among the first in the world to use the Hugo RAS system and to contribute to the global patient registry.

A work of art to commemorate this historic moment

Professor Giovanni Scambia asked Maestro Giovenale to interpret this historic moment in the field of robotic surgery through his artistic sensitivity. "La Luce dell'anima" is a piece of art that is part of a special path desired by Professor Scambia to narrate all the themes of research about women's health with the language of art. “Patients - explains Professor Scambia - have two fears regarding robotic surgery; the first is that it is the robot and not the surgeon who operates; the second is in general on the use of technologies in medicine, when they replace the hand of man. This picture precisely means that whoever works through the robot is always the surgeon's hand, guided, according to our sensitivity as Catholics, by the hand of God. In the picture there is also a stylized guardian angel and a series of luminous holes, which help us to see beyond, the invisible".

In 2021, Medtronic's Hugo RAS system received the CE (Conformité Européenne) mark, which authorized its sale in the European Union, for urological and gynecological interventions, while other indications will be confirmed shortly.

"The arrival of Medtronic's Hugo robot-assisted surgery system - says Michele Perrino, President and CEO of Medtronic Italy - marks a new era of robotic surgery, which makes healthcare technology more accessible, overcoming the barriers related to the cost that have held back its adoption. Leading-edge also in vertebral surgery, thanks to the Mazor ™ robotic platform already available on the market, for Medtronic, innovation, the use of technology and data analysis, which are the characteristics that distinguish also the robotic surgery system assisted Hugo, are key drivers for improving health outcomes and extending access to care by democratizing surgery. The adoption of the Hugo robot-assisted surgery system in a center of excellence such as the Gemelli University Hospital Foundation confirms our willingness to collaborate with Institutes that share our vision, taking another significant step to make minimally invasive robotic surgery accessible to more patients and health facilities in the world, thus contributing to a real transformation of the health system in which innovation and technology play a fundamental role ".

Original Article: https://then24.com/2021/10/27/implanted-in-italy-revolutionary-artificial-retina-that-gives-a-bionic-sight-to-blind-patients/

For the first time in Italy, NR600 has been implanted, a revolutionary latest generation artificial retina produced in Israel that gives bionic vision to completely blind patients. The implant was performed at the Gemelli Polyclinic in Rome on a seventy-year-old patient suffering from a severe form of retinitis pigmentosa.

Here’s how the device works and how the man will see.

The NR600 artificial retina.

Al Gemelli Polyclinic in Rome one was implanted artificial retina from latest generation to a seventy-year-old patient blind, due to an advanced form of retinitis pigmentosa.

This is the sixth plant in the world and the first in Italy of this revolutionary device, developed by the company’s Israeli engineers. Nano Retina of Herzliya, is not far from Tel Aviv, where numerous start-ups in the high-tech sector are based (a bit like California’s Silicon Valley). The artificial retina – called NR600 – was implanted after an operation that lasted about two hours.

The patient has already begun to see the light, an extraordinary result for those who have been in the dark for years; it will take months of brain testing, practice and adaptation, but eventually, he will learn to manage his new vista bionic.

The artificial retina does not return natural sight, however, it allows to distinguish shapes and objects, greatly improving the life quality when it becomes completely blind due to retinitis pigmentosa.

The implant was carried out by the team led by Professor Stanislao Rizzo, director at the Ophthalmology Unit of the Agostino Gemelli IRCCS University Hospital Foundation and professor of the Ophthalmology Clinic at the Catholic University campus in Rome.

The scientist is a pioneer of these interventions, having been the first to have implanted the artificial retina in Italy “Argus“In 2011 in a blind patient. In ten years, technological progress has been significant; unlike the old model, which just had 60 electrodes, the NR600 does not contain 400, significantly improving the final result.

As explained in a press release from Policlinico Gemelli, the new artificial retina is as big as the tip of a pencil, with a diameter of 5 millimetres and a thickness of 1 millimetre; should be placed by an eye surgery expert directly on the retina, making sure that the electrodes penetrate the cells and replace the fotorecettori destroyed by the disease.

Thanks to specific stimuli, the electrodes activate the ganglionari cell, responsible for the transmission of brain visual information. The process is accomplished by wearing special glasses which send an infrared pulse to the NR600 by powering it.

Original article: Prestigioso premio per l’innovazione tecnologica assegnato a un giovane cardiologo del Gemelli - Policlinico Universitario A. Gemelli IRCCS (policlinicogemelli.it)

The Jon DeHaan Foundation annually awards the two best abstracts on technological innovation in the field of interventional cardiology, selecting them among the approximately 2 thousand, submitted to the EuroPCR international congress, dedicated to interventional cardiology. And this year, the prize was awarded equally to Dr. David Kuraguntla and Dr. Domenico D'Amario of Gemelli.

"The award," comments Dr. D'Amario, "consists of a large sum of money to be used for the improvement and implementation of the awarded research. I have not yet decided how to use these funds, but the three areas I am considering are the further development of this device also in association with devices already available in clinical practice, the implementation of a clinical pathway dedicated to patients followed in digital mode with heart failure, and the development of educational projects aimed at medical staff in training and technical/nursing staff in order to improve, with the help of technology, the patients with advanced heart failure's healthcare experience, always remembering that the development and success of any innovation is based on the passion, collaboration and dedication of all the professionals involved and the shared pathway and willingness of our patients."

Patients with advanced heart failure represent a challenge for modern cardiology, also for their number: in fact, about 2% of the European population is affected by this pathology. Heart failure has a significant impact on treatment pathways and weighs on the direct and indirect costs of healthcare, also due to the numerous hospitalizations due to the exacerbations of their pathology.

"The work we sent to EuroPCR presents the world's largest experience ever with the use of the V-LAP device (see 'Heart: under special surveillance') on the world's first 24 patients, 5 of whom were implanted at Gemelli Cardiology ward and followed up for more than a year. In the world, we are the center that, along with the Israeli center, has implanted and followed up the largest number of these devices, developed by the Israeli start-up Vectorious Medical Technologies, and our follow-up was the best performing. In fact, we were able to show that, thanks to this special 'sentinel' microcomputer that is implanted in the heart at the level of the interatrial septum, none of the followed patients, no matter how severe and very complex, needed to be hospitalized for heart failure flare-ups. All changes in therapy were promptly made electronically, based on data provided to us by V-LAP and before the onset of symptoms."

But not only that. Positive repercussions were also felt on the patients' perceived quality of life; V-LAP turned out to be highly appreciated by both patients and their caregivers because this type of technology, far from making healthcare less 'human', conveyed to them the concrete presence of the medical and nursing staff, always at their side for a comprehensive and daily takeover of their care needs. In short, V-LAP has resulted in both an objective improvement in biological parameters and in patients' quality of life.

"This is the first ever experience in the world made with V-LAP on this number of patients - concludes Dr. D'Amario - and the excellent results obtained have led us to this prestigious award".

The V-LAP device is currently only implantable in a clinical trial and is not yet on the market.

Original article: https://www.policlinicogemelli.it/news-eventi/al-policlinico-gemelli-nasce-il-centro-integrato-di-isteroscopia-digitale-piu-grande-del-mondo/

Endouterine pathologies treated at the same time

Gemelli CLASS Hysteroscopy Centre

The new CLASS Hysteroscopy Centre of Gemelli University Hospital Foundation has three operating rooms dedicated to digital hysteroscopy. A similar project on a smaller scale had been realised in Leuven (Belgium) with the creation of an integrated operating theatre dedicated to digital hysteroscopy, followed by another centre inaugurated a few months ago in Shanghai where there are 2 integrated theatres. "Our ambitious project, which has now become a reality," explains Professor Giovanni Scambia, Director of the Gynaecology Oncology Unit of the Gemelli University Hospital, Full Professor of Gynaecology and Obstetrics at the Cattolica University in Rome, "has lead to the creation of 3 integrated rooms dedicated to digital hysteroscopy. Each room has the most advanced technologies in terms of endoscopic image management and three-dimensional ultrasound and all the most innovative tools for the management of endouterine pathologies".

Thanks to the extreme miniaturisation of the instruments and endoscopic optics of the smallest size and highest quality, and thanks to the presence of a 3D ultrasound scanner in every room, it will be possible to treat any endouterine pathology at a single time. "We will therefore overcome the former model which forced the patient to go to hospital several times to perform ultrasound, diagnostic hysteroscopy, pre-hospitalisation with examinations, and then operative hysteroscopy in the operating theatre, in order to welcome her in the Integrated Digital Hysteroscopy Centre," Professor Giovanni Scambia continues.

The patient pathway, the preparation and observation areas and, above all, the operating theatres have been specifically designed and built to perform digital hysteroscopy procedures, integrating all the necessary technologies and guaranteeing maximum comfort and safety for patients and operators.

"The flagship of the CLASS Hysteroscopy Centre," concludes Professor Scambia, "will be the management of patients with uterine malformations and the management of patients with endometrial cancer in fertile age, for whom a dedicated Clinical-Assistance Pathway has also been activated.

The centre was also realised thanks to the sensitive support of the Onlus association "Oppo e le sue stanze".

Original article: Cuore: sorvegliato speciale (anche da remoto) in caso di insufficienza cardiaca - Policlinico Universitario A. Gemelli IRCCS (policlinicogemelli.it)

The Cardiology Team

Patients with heart failure are always under special surveillance because their condition can easily turn into dangerous life-threatening flare-ups, generating frequent emergency room visits and hospitalizations.

However, in times of emergency, such as those that have occurred in recent months, it becomes very difficult to follow these patients on an outpatient or inpatient basis, because this in the COVID era can be very risky indeed.

Technology and telehealth can meet the needs of patients and caregivers: making a virtue of necessity in such difficult times, experimental pathways have been implemented that are likely to be routine in the near future.

For months already, a trial of a special heart failure monitoring system, developed by Israeli start-up Vectorious Medical Technologies, has been underway in several countries including our own. It is the V-LAP, a real microcomputer (weighs 5 grams and measures about 3 mm) that looks like a spinning top of twisted metal wires.

V-Lap is implanted in the heart at the level of the interatrial septum (the thin wall separating the two atria) with its antennae 'looking' toward the left atrium.

The cardiologist ascends to the heart, starting at the femoral vein, with a special catheter on the tip of which V-LAP is placed.

The implantation technique is the same as that used for 'umbrellas' that close congenital heart cavity defects. The procedure is performed under sedation and lasts less than an hour.


A sentinel in the heart

V-LAP is a sentinel that promptly reports what is happening in the patient's heart and promptly alerts the physician to increases in left atrium pressure that may precede, even by weeks, symptoms such as wheezing or palpitations.

Before this occurs, the physician can contact his patient and modify his therapy, such as by increasing the dose of diuretics. This will avert the crisis and save the patient a trip to the emergency room and subsequent hospitalization.

This technological gem is a sensor, which communicates left atrium pressure readings to a special belt worn by the patient, which acts at the same time as a receiver of the signal from the heart and as a battery (V-LAP charging from outside by induction).

By pushing a special button on the belt, the patient sends the information received from the sensor once a day to the cloud, from where his or her cardiologist reads it.

The physician is thus able to assess his patient's degree of compensation at any time, even from his cell phone day by day, without having him come to the clinic, but by reading his data remotely and can intervene quickly to change his therapy, before heart failure flares up again.

"This technology," comments Dr Domenico D'Amario, medical director at the UOC of Cardiology at the Agostino Gemelli IRCCS University Polyclinic Foundation (directed by Professor Filippo Crea) and a member of the European Society of Cardiology-Health Association on Heart Failure (ESC-HFA) Committee on Training and Implementation of Telemedicine and e-health, "allows us to have direct measurements from the left atrium, something that until now was only possible by resorting to an invasive test such as cardiac catheterization. Having these measurements available is important because increased pressure in the left atrium precedes the onset of symptoms by a few days. The other advantage is that this system does not run on internal batteries (which would become difficult to replace), but is recharged by induction from the outside. It is connected to a cloud platform, from where the cardiologist can check daily how the pressure in his patient's heart is doing and then modify his therapy as needed. This is a very important innovation, especially for frail patients; this also helped us a lot during the pandemic emergency, when having these patients come to the hospital would have been really risky. But also in the future, monitoring these patients remotely will offer great advantages, decreasing the number of medical contacts within the hospital and envisioning a more shared management of complex chronic diseases between high speciality centres, the patient and the territory. Tools such as V-LAP will allow us to remotely manage and treat these patients outside the hospital, activating a network with family physicians and home care, thus limiting hospital access to only the most serious cases requiring hospitalization."

Evaluation of the safety and accuracy of the data sent by V-LAP is ongoing in four countries around the world (Italy, Israel, Germany, and Great Britain) within the VECTOR-HF study; this is the first time this sensor is being tested in humans, on about 20 patients.

"At Gemelli," Dr D'Amario reveals, "two have already been implanted (on two patients aged 75 and 60), but we already have others waiting. The results obtained so far will be presented on June 26 as a late-breaking clinical trial, in the part dedicated to innovations, at the Euro-PCR congress, which is the European Society of Cardiology (ESC) congress dedicated to interventional cardiology."

What is heart failure and how to treat it

Heart failure is a very common condition, especially in the elderly population and causes frequent hospitalizations for flare-ups.

The patient presents with air hunger, and swelling of the ankles and legs, reports great exhaustion, does not breathe well at night when lying down, may experience digestive disturbances, and complains of decreased appetite.

All this is due to the fact that the heart muscle, weakened by the failure, can no longer pump oxygenated blood to the organs, and this causes a buildup of fluid not only in the legs but also in the lungs, leading to what is known as acute pulmonary oedema, which is the emergency that brings these patients to the emergency room.

This condition is treated with a variety of drugs (ACE inhibitors, beta-blockers, anti-aldosteronics, neprilysin/valsartan inhibitors, dapagliflozin, diuretics) and with special anti-blood pacemakers. Fundamental is careful monitoring of the patient's condition and weight (sudden weight gain should suggest fluid accumulation and thus risk of pulmonary edema).

The extent of the problem

It is estimated that at least one million Italians (1.7 percent of the population) suffer from heart failure (worldwide 27 million patients, 7 percent of the elderly population). This condition is the culmination of a range of heart diseases, from heart attack to valve disease, to congenital heart disease. In our country, heart failure is the leading cause of death from cardiovascular disease (one in two patients dies within 5 years of diagnosis) and is the leading cause of hospitalization, generating 190,000 hospitalizations a year, at an estimated cost of 3 billion euros.

"This condition," Dr. D'Amario concludes, "has a prognosis overlapping with that of advanced cancer, but people, and patients themselves, are not aware of this risk. The consequence is that these patients often come to us late and in poor condition."

Original article: Al Gemelli ART trattati primi pazienti oncologici in Italia mediante acceleratore lineare ibrido con risonanza magnetica - Policlinico Universitario A. Gemelli IRCCS (policlinicogemelli.it)

After having acquired two years of experience with the first version of this innovative technology, at Gemelli ART a new hybrid linear accelerator MRIdian ™ - ViewRay (ViewRay, Mountain View, CA, USA) is now clinically active. This is the most modern radiotherapy image-guided solution, currently available to treat patients with lung, liver and prostate malignancies.

The treatment unit consists of a magnetic resonance (MRI) scanner with a field strength of 0.35 T and a 6 MV linear accelerator capable of rotating and radiating the patient from 360 degrees, while specific technical measures allow radiation to effectively reach the target without interaction with the magnetic field.

The presence of integrated magnetic resonance imaging allows to acquire static images of excellent morphological quality for the initial positioning of the patient and to actively monitor the treatment through the acquisition of dynamic images on which it is possible to verify in real time the position of the tumor for the entire duration of the treatment.

This technological solution allows to automatically stop the irradiation when the tumor is not in the expected position due to the patient's natural movements (such as breathing or heartbeat). This technology, allowing a controlled delivery of radiotherapy, allows to administer higher doses on the tumor and to offer greater chances of healing.

The patient can check the position of his illness at any time through a screen and, by controlling his breathing, helps to keep his disease in the best place to be irradiated. It is the first technological solution that allows the cancer patient to participate directly in the treatment of his disease.

Very recent software developments also allow to realize treatments in "online adaptive" mode optimizing the dose distribution on the patient's daily anatomy and thus obtaining safer treatment plans reaching higher doses on the target and obtaining excellent clinical results in terms of local response and survival and reducing toxicity and side effects.

The importance that the patient's calmness plays for the healthcare professionals during treatment is evidenced by the decoration of the therapy room, made entirely by the workers of the Teatro dell'Opera di Roma (Maestro Varamo) designed by the Creative Design of the Maison Valentino, Pierpaolo Piccioli, who projects the patient into a dreamlike dimension of contact with nature and with his own being.

Prof. Valentini and Pierpaolo Piccioli, Creative Director of Valentino
Gemelli Rome Triangle


Gemelli Rome Triangle