It's like a scene from a James Bond movie. In a room with gleaming steel walls, double doors slide open to reveal a doughnut-shaped machine large enough to engulf a person. People start backing away. The machine advances smoothly on ceiling tracks until it starts to swallow the top half of the young woman lying prone on the operating table.
Something beeps. The machine stops.
"Did we hit something?" someone asks. "No," comes the answer, and the machine inches forward again.
This summer, Abbott Northwestern Hospital in Minneapolis unveiled its most expensive operating room to date, built and outfitted at a cost of $9 million.
It's used for brain surgeries and includes a magnetic resonance imaging (MRI) machine that slides in and out of the room during intervals in surgery.
Surgeons use the images to guide their instruments and make sure they haven't left part of a tumor behind, improving the odds for recovery.
"It's better than the eye of a surgeon, better than a CT scanner, better than an ultrasound," said Dr. Douglas Yock, MRI director at Abbott Northwestern. He said the investment will help the hospital maintain its lead in neurosurgery.
It's the latest salvo in the Hospital Wars. The tale of how Abbott got its new operating suite may not include spies or espionage. But it does include seven years of investigation, dispatching scouts to foreign locales and tracking the moves of rivals.
It also illustrates how hospitals constantly try to best each other in the pursuit of the newest technology as they strive to raise their profiles and increase patient referrals that are their lifeblood.
Arms race in technology
"It's a very thorny problem," said Dr. Robert Harbaugh, a spokesman for the American Association of Neurological Surgeons and chairman of neurosurgery at Penn State. "There is what amounts to an arms race in a competitive market, especially in neurosurgery, where it's very technologically sophisticated. If one hospital gets a new gadget, then the other hospital needs to get the new technology to compete."
Abbott says it has the first such MRI machine in Minnesota, the fourth in the country and the fifth in the world. But that depends on how you define "first."
The Mayo Clinic unveiled its own version in Rochester nine months ago, and Mayo doctors say it is superior. Regions Hospital in St. Paul has had a smaller, portable one for a year, which it describes as more "cost-efficient."
Then there's the one at the University of Minnesota Medical Center-Fairview, installed medical light years ago, in 1996. Physicians have used it for pioneering work on deep brain stimulation for diseases such as Parkinson's.
And starting in September, United Hospital in St. Paul can boast another first -- a movable MRI machine connected to not one, but two operating rooms.
The proliferation of the high-tech machines has made the Twin Cities and Boston the leading centers for this type of surgery in the United States, said Dr. Chip Truwit, chief of radiology at Hennepin County Medical Center. (HCMC has an MRI machine that can be used for minimally invasive procedures, but isn't a big center for brain surgery.)
"It's now the standard of care for brain tumors in this city," Truwit said.
Choosing the right machine
Abbott is one of three hospitals in Minnesota that regularly makes the list of best hospitals in America for neurology and neurosurgery, as ranked by U.S. News & World Report. This year, Abbott ranked 22nd, the University of Minnesota Medical Center-Fairview was 20th and the Mayo Clinic in Rochester was No. 1.
Abbott does 400 brain operations a year and is reimbursed from $12,000 to $65,000 each time, depending on the complexity of the case and the type of insurance contract.
In 2000, the hospital began its search for an MRI machine to guide brain surgery.
The technology helps neurosurgeons visualize tumors even before the first cut. Also, tissue can move during a procedure, making some pre-surgery images obsolete.