Copernicus™ Connect

Interventional MRI (iMRI) offers the potential to expand minimally invasive care. But building a successful program requires more than advanced imaging technology. Healthcare teams must navigate suite design, workflow development, training, reimbursement, and clinical adoption while balancing operational and financial goals.

In this video, members of the Copernicus support team and experienced clinicians share practical insights from the Cook iMRI Research Suite, exploring what it takes to move from interest to implementation. The discussion highlights key considerations for developing an iMRI program, lessons learned from real-world experience, and strategies to help institutions expand access to MRI-guided intervention.

Welcome, and thank you for joining us today. I’m excited to be with you. Whether you’re here to learn about interventional MRI for the first time or you’re actively exploring how to bring it to your institution, we’re glad you’re here. Over the next few minutes, you’ll see the technology, hear from physicians, and learn what it takes to build a successful iMRI program. But before we do that, let’s start with the challenge that brought us here together. For years, you’ve worked at the edge of what imaging allows, but for clinical judgment outpaces your visualization tools. CT gives you a snapshot. Fluoroscopy gives you no soft tissue contrast. Your current guidance tells you roughly where you are, but is roughly good enough? Not for every case. The gap between what you can do and what you can see, it closes today. I’m Pete Polverini. I lead the iMRI division here at Cook Medical. And this is the first Copernicus™ Connect event. We named this “Copernicus,” and here’s why it matters. Nicolaus Copernicus didn’t invent the stars. He moved the center point, changed what everything else orbited around. In doing that, the universe suddenly made sense. That’s what we believe interventional MRI does. It moves the center point of the procedure from the imaging protocol to the patient. Real-time visualization. In the bore. No radiation. The imaging follows the procedure, not the other way around. Copernicus is also the name, the platform for the institutions, building an iMRI service. From the earliest planning conversation all the way through the implementation, the growth and the long-term success. You’ll hear more about Copernicus throughout this event. Over the next few minutes, three things are going to happen. You’ll see the suite; you’re going to walk through an environment that was designed from the floor up for intervention. Every decision has a clinical reason. You’re going to understand the changes clinically, and we are going to be specific about the patient populations and the procedure types, where iMRI guidance gives you those capabilities you don’t currently have. You’ll hear from physicians who operate currently in this environment, and you’ll understand what it takes to build a program. We will walk you through the financial case. And I’m going to come back at the end and tell you exactly what’s next. Now, let’s start with the room.

This is an iMRI Suite. This is not a diagnostic MRI environment. That distinction matters, and I want to make it clear before we go anywhere else. A diagnostic MRI room is optimized for image quality. Every decision in that room—the bore orientation, the table, the RF shielding—is made in service of producing the best diagnostic image for a radiologist reading it after the fact. This room was optimized for something different: a physician guiding an instrument through tissue in real time with MR imaging running continuously. Not a pre stand, not a post-procedure check. Continuous. Every element of what you’re looking at was designed around that single requirement. Let me walk you through every key component. The MAGNETOM Free.XL™* is at the heart of the iMRI Suite. Designed to meet the specific demands of interventionalists, it provides high-performance imaging without ionizing radiation and with exceptional patient access, enabling crisp real-time visualization throughout procedures. The system operates at 0.55 Tesla. This field strength was chosen specifically for interventional work. I want to address that directly because a lower field strength is sometimes read as a limitation. It is not. It’s a deliberate clinical decision. At this field strength, you have the tissue contrast you need for procedural guidance. More importantly, a greater range of medical devices can be brought safely into the 0.55 Tesla field. And these devices generate a more refined artifact, leading to a greater precision in targeting and placement. Your device is visible in the imaging field. The tissue you are targeting is visible, both, simultaneously. That combination, device visibility and target visualization at the same time, supported by software guidance, is exactly what’s required for interventional procedures. The ultra-wide flared opening here gives the interventionalist access to the patient from multiple positions. That sounds like just a specification. What it actually means: You can easily and efficiently access the patient at all stages of a clinical procedure. The equipment is adapted to the procedural environment. Another example of this adaptation is the inclusion of a dockable table, which allows more efficient patient preparation, transfer, and access in the case of emergencies. Real-time procedure guidance requires tight synchronization between the clinician doing the work and the MR technologist controlling the imaging, adjusting sequences as the physician’s instrument moves. They carry on a continuous conversation for coordination and a continuous display of visual data to inform the clinician. Real-time navigation requires the right images in the right place at the right time. This room has special monitors mounted so we can position them for optimum visibility whether we’re inbore or tableside. This gives the doctor the continuous imaging needed for device guidance. We also give the context: reference images for anatomical context and the guidance plan so the team can anticipate what’s coming next. This second screen displays that information or any other context data the doctor wants. These aren’t interventional monitors. The MR system places huge constraints on nearby electronics. So, these are custom MR-conditional monitors that work and don’t affect MR imaging when placed in the optimum clinical location right beside the MR. Just like we give context to the clinician, it’s equally important to give the MR tech context. There’s a camera on the ceiling above me, giving a top-down view of the patient. There’s also a camera on the wall behind me and one on the far wall looking down the bore. These cameras, together with the large viewing window from the control room, allow the whole team, including the MR techs, to see the procedure and monitor the patient from outside the room. This camera coverage gives the whole team clinical context. When everyone can see what’s going on with the patient, they are better prepared for what comes next. Video is vital, but the team also needs to be able to talk to each other. MR is a noisy environment, and the iMRI team is separated by distance and even by walls. Here you can see a headset. This is part of a custom MR-conditional audio system designed specifically for this environment and the needs of interventional MR communication. With it, we create one conversation that spans rooms and brings the whole clinical team together. This is not a convenience feature. For complex cases with real-time needle adjustments, team-wide audio is a necessity. This is a surgical environment, and it has space for the same equipment you’d see in a traditional interventional suite or cath lab. All of this equipment is MR conditional. You can see here how I have space to position a mayo table and an instrument table in my clinical zone. There’s enough space in the room to have back tables and supply cabinets for my surgical supplies without blocking our circulation paths. When not in use, there is room to position these tables out of the way. Another important way we’ve merged MR and IR is in the integration of anesthesia. iMRI rooms have the full complement of anesthesia gases. And we have tested and approved MR-conditional anesthesia systems at 0.55 Tesla. This iMRI procedure room is big enough to store anesthesia equipment when not in use and to position it near the patient, but out of the clinical zone, during the procedure. Everything we’ve discussed so far assumes access from the side of the patient. But not every procedure is performed from that position. Here at the head side of the MRI, you can see our second clinical zone with a second set of monitors and space for our clinical tables and supplies. This creates a complete clinical work zone for TIPS procedures, cardiovascular procedures, and other interventions requiring jugular or neck access. Guidance gets us to the target. The next step is delivering therapy. The iMRI Suite is for much more than biopsies and other needle-based procedures. It is a robust ecosystem for a wide range of access and treatment, including ablation and, in the future, cardiovascular procedures. Regarding ablation, iMRI provides more precise guidance for probe placement and more accurate real-time feedback on treatment progress, enabling more successful treatments. As we look to the future, the space is already designed to support even more advanced needle-based and cardiovascular procedures. Everything you just saw was built around one question: Does this serve the physician treating their patient? This room was built for intervention, and the difference is visible in every element of the design.

That was an excellent overview of the iMRI Suite and the technology that makes it possible. But a sophisticated environment only matters if it solves meaningful clinical problems. So let’s talk about where iMRI fits into patient care. iMRI is not a replacement for CT, and it’s not a replacement for fluoroscopy. Those modalities are not going anywhere, and the goal here is not to displace them. The goal here is to enable the clinical capabilities that you do not currently have. Real-time, high-contrast soft tissue visualization during a procedure without ionizing radiation. That’s a different tool for a specific class of clinical problems. So let’s be more precise about which problems. First, let’s just discuss those patients that benefit from improved soft tissue targeting. Let’s talk about the patient with a soft tissue lesion that is clearly visible on MRI and poorly characterized on CT, where today you navigate by landmarks. Let’s also talk about the delivery of therapy, where the targeting margin matters oncologically. Or an oblique approach or anatomical complexity where CT-guided access is a real challenge today. In ablation procedures, real-time monitoring of the treatment zone during the procedure, not just a post-procedural scan, not a confirmation image, changes the clinical decisions that you can make in the room. We’re not guessing whether your ablation margin is adequate. We’re watching it. These patients exist in your practice today. Now let’s talk about those patients where radiation exposure is a concern. These could be pediatric patients, or the patient of reproductive age, or the patient that you know is going to undergo repeat procedures for a recurrent lesion or difficult problem. Every additional imaging dose in these patients is a clinical decision that should be made consciously, not absorbed as the default cost of the procedure. iMRI makes that dose avoidable. And I’d also like to talk about those patients that today you’re not able to serve, you may be turning away, at least for a little while. That biopsy target that is not safely approached under CT, either because of a sensitive structure nearby or immediately behind the lesion. Or an example like a small liver lesion, high in the dome, where you can’t be assured of the diagnostic value of the procedure. Or the patient where you’ve already tried the procedure under another imaging mode, and it’s come back inconclusive or incomplete. These are not future patients. They are patients whose needs are unmet right now. Waiting for an imaging capability that your current procedural toolkit does not include. What iMRI changes for these three groups is not incremental; it’s categorical. The procedure is either possible, or it isn’t. The margin is either visible, or it isn’t. To reinforce this, let’s hear from a couple of physicians who operate in this environment today.

For me as a physician, having the possibility to use also MRI in my daily life, working life, and treating patients, means a dramatic increase in confidence in what I’m doing, safety for the patients, and also for the patient outcome at the end. This can only be done if you have support from industry. And looking at the cooperation of Siemens and Cook makes me really feel happy that there’s such a strong industry support to make this even better for me and my patients. Interventional MRI gives a super high confidence doing the procedures. It’s the easiest method to learn. Doing procedures under CT guidance, it is just gray. You don’t see a lot of risk structures, and you don’t know sometimes if you really hit the target. In interventional MRI, it’s exactly the opposite. So, you see exactly what you are doing. At the end of the procedure, you are perfectly confident with the safety of your procedure and with the result.

You want the flexibility of an interventional suite, and you want the safety of having your nurses and/or your anesthesiologist being able to access the patient. So, what do I see the room look like? Ideally, it would be spacious enough to accommodate my equipment and planned out to a point where any interventionalist could walk in and with minimal training, know what they were doing. It would have a seamless communication device where I can talk to the patient if I need to. I can talk to my nurse, I can talk to my technologists, I can talk to my other physicians. It would have the ability to bring in a consultant, if necessary, to take a look at the imaging in real time. I want to be able to be in a physical space where I could use ultrasound if I need to, safely, to do minimal things like needle access into lymph nodes or needle access into a vein for a venous procedure. And I want the ability to have patient safety be paramount. So, if something, God forbid, were to go wrong, my team could get the patient to a place that was safe and perform the necessary emergent procedures. This is something different and new. And anytime we bring something different and new into the hospital, you need champions who are willing to be excited, to learn about it, become expert in it, so that they are driving the care to safety and success in that area. You need a physician who is going to be a champion. You need a technologist who’s going to be a champion. You need a nurse who’s going to be a champion. And in many cases, you need an anesthesiologist who’s going to be a champion or at least willing to play with you a little bit. And I will tell you, one of the most critical components to the room is that technologist who is going to be running the scanner in direct communication with the radiologist or the interventionalist or the physician provider. That’s the most critical part. It’s not just the equipment in the room, it’s the team. And then let’s add into that team someone who’s learning, so they can take it out into the world.

What you just heard is consistent with what we hear from every physician who’s worked in this environment. The clinical value is not theoretical; it’s a procedural reality in cases that are affecting patients’ lives today. The clinical case is clear. The capability is real. The question every institution asks after this conversation is exactly the same. How do we build this? And what does it actually take to go from where we are today to running these procedures in our institution? Moises Cruz leads our commercial and financial strategy, and he’s going to walk you through the numbers. And when he’s done, Pete is going to tell you exactly how Cook supports every step of that journey through our Copernicus program.

You’ve seen the clinical benefits. They are real. But for most hospitals, clinical value alone isn’t enough. You also need to know the program can pay for itself. The good news, MRI-guided procedures are reimbursable today. Not under investigational frameworks, not pending future approvals. They covered under established CPT® codes, included MRI Guided Ablations, MRI Guided Biopsies, and MRI Guided Pain Procedures. The billing infrastructure already exists, and it is in use today. Your CFO and your service line director won’t ask, “Can you get paid?” They’ll ask, “How many procedures will we do? And when does the program pay for itself?” That answer is different for every hospital. It depends on your patients, your referral patterns, and how you plan to pay for the suite. Cook built a financial model for exactly this. Your team enters your own numbers, and it shows a projected profit and loss for your program. Let me show you the four areas behind it. Capital investment: The specific cost of the iMRI Suite that’s right for you, and it can be adapted as needed. Change any option and the total updates right away. Procedure volume and reimbursement: The model allows for customization to your case and volume goals, based on your clinical scope and your payer mix. Turn a procedure on, off, and watch your volume and your Medicare mix update immediately. Operating costs: The added cost your suite may need, things like extra headcount, service contracts. and other expenses. Financing and financial variables: How you plan to pay, cash or financing. Choose how you finance it, and the model adjusts your returns to match. At the end, you get an estimated revenue per procedure, a 10-year cash flow, and an estimated break-even point. And the calculator is dynamic. We can adjust it together, live, while we talk. Here’s what the model shows across many hospitals. iMRI does not need a very high volume to make financial sense. At a moderate volume, often possible in your first full year, the numbers work. So don’t think of MRI as a cost center. Think of it as a strategic service line. It helps your hospital to stand out, and it captures patients who would otherwise go elsewhere or never get the procedure at all. But there’s one thing the model can’t show you. MRI guidance makes some procedures possible that don’t happen today. Patients where CT guidance isn’t precise enough. Patients who can’t receive more radiation. And patients whose lesion is only visible on MRI. Those patients are not a revenue projection. They are a clinical responsibility. And they don’t have a line item in a financial model. But they are the clearest argument for building this capability in your institution. To close, we’ll return to Pete for a final perspective on why this work matters.

So, you’ve seen the room. You’ve heard from the physicians who work in it. You understand the clinical case and the financial case. Here’s a thing we haven’t said yet: Technology gets you to the room. It does not get you to the procedure. iMRI adoption has a history. There have been earlier attempts at interventional MRI programs that were unprepared, where the suite was built, but the clinical infrastructure around it was not. Where teams were trained on equipment, not the workflow. Where the investment was made and the utilization did not follow. Copernicus is Cook Medical’s clinical readiness platform for IMRI. It begins before the suite exists with the facility design guidance, the business case to support, and it continues after your program is established, with ongoing case support, new physician onboarding, and a clear pathway to recognized excellence. There is a progression. We’ll start with Copernicus ready, which begins on the first day of planning. The next stage is Copernicus certified, which will take you through your first case to a recognized program that peers want to visit and patients seek out as a Copernicus center, and drive to iMRI centers of excellence, which are the institutions that will teach, they will train and deliver publications for understanding different disease states. We are building that community right now. The first sites are live. The designation is real. Precision takes preparation, though. That is not a slogan, it is the clinical reality of operating in a new procedural environment. The suite delivers the precision. Copernicus delivers the preparation. We’ll give you a consultation link in just a moment. That is the first step. It is a structured conversation about your facility, your patient population, and whether the iMRI program is the next right step for your institution. Some institutions that start the conversation and we’re going to move forward immediately; others we’re going to need some more time. Both are the right answer. What matters is the conversation is happening now. Because the patient who needs the capabilities exist in your market today. The room is built, the program is ready. We’ll see you in it.