**6. Future directions in ioMRI**

AMIGO (Advanced Multimodality Image Guided Operating Suite) is a threeroom configuration involving the PET-CT room, operating room, and MRI room. It involves multidisciplinary teams to guide treatment before, during, and after surgery in the operating room. PET provides functional and metabolic information with molecular biomarkers. The combination of MRI and CT with PET gives anatomical, functional, and metabolic combined information to surgeons intraoperatively for further decision-making [37].

MRI-guided focused ultrasound (MRgFUS) is a noninvasive thermal ablation method.IT uses MRI for target identification, planning, and energy deposition. It allows to ablate targeted tissue without damaging normal structures. MRgFUS has been approved for the treatment of uterine fibroids. It is also evaluated for targeted drug delivery and gene therapy, which can temporarily change vascular or cell membrane permeability and release or activate various compounds. High field strength of MRI (3 T) aids better quality of images it helps both diagnosis and surgical ablation. 3 T MRI also has improved sensitivity to temperature measurements which enables multi-slice or three-dimensional thermometry. Trails are being conducted for its use in brain tumors [38].

The Smart Cyber Operating Theater (SCOT), the next generation operating room has been developed by Japan Agency for Medical Research and Development with AMED. It has a treatment room communication interface called "OPeLiNK" which projects all the information like patient data, navigation, IONM, anesthesia monitoring, operative field, ioMRI, etc. in a 70 inch screen. Approximately 20 types of equipment are connected to the system. Surgical information from these sources are sent through an application and displayed to the surgeon and it enables precision in surgery with low risk and high therapeutic effect [39].
