A radiologist’s perspective on how imaging technology can help solve some of healthcare’s biggest challenges
Estimated reading time: 12-14 minutes
Focusing more on the patient can boost the productivity and efficiency of MRI procedures
Arjen Radder, business leader, global MRI at Philips, talks with cardiac radiologist, Dr. Christoph Juli on a range of imaging topics from diagnostic confidence to staff engagement to reimbursement to total cost of ownership. In particular, Dr. Juli shares his thoughts on why diagnostic confidence is both art and science, how speed is increasing MRI’s potential for diagnosing disease, the reasons patient comfort must be combined with communication and trust, and what is driving a potential reality in which we may see MRI scanners in shopping malls in the near future.
Arjen Radder, Philips: When Philips hosted its #theNextMRWave livestream panel discussion a couple months ago with radiologists from around the world, I found it most interesting that the consensus of all these experts was that we cannot narrow it down to a single method when it comes to the best way to improve diagnostic confidence in MRI without compromising productivity or patient comfort. To me, that underscores the complexity of the challenge in imaging and the value of an integrated, outcome-focused solution.
Dr. Christoph Juli, radiologist: That’s exactly right. Diagnostic confidence is a balance of both art and science; it’s imprecise and intuitive as well as researched, measured and objective. We need to focus on many areas: improving image quality through clinical innovation; exploring AI to advance diagnostic confidence; adopting quantitative imaging techniques for decision support; and training and educating our staff.
Arjen Radder, Philips: Speed, comfort and confidence used to be competing factors in MRI but they are not anymore. What excites you the most about recent MRI technology advancements and how it can impact patient care?
Dr. Christoph Juli, radiologist: The breakthroughs in speed in MRI technology is opening up a whole new area of potential for better diagnostic confidence and screening of diseases (e.g. body composition imaging) that were not feasible before due to the length of MRI scans. With technology such as Philips Compressed SENSE used with MRI, we can make imaging exams faster than before with high image quality even with a demanding cardiac exam. It is particularly important in cardiology where early detection of heart disease or prediction of heart failure – before a heart attack happens unexpectedly - can make a significant impact on patient outcomes.
Arjen Radder, Philips: During the panel discussion at #theNextMRWave Livestream event, one of the attendees asked, “With such huge pressures on productivity, is comfort really as important as speed and confidence?” You had an interesting answer on the importance of comfort that reinforced some of the feedback we received from real patients in our Patient Experience of Imaging Research that in addition to comfort they value communication and trust in the doctor. Can you explain your thoughts on it in more detail?
Dr. Christoph Juli, radiologist: What some people don’t understand is how the comfort of the patient, or lack thereof, affects productivity or speed and diagnostic confidence. If a patient isn’t comfortable then there is a greater chance that they may move during the exam which creates motion artifacts and affects image quality and diagnostic confidence. It could also mean they need to do a rescan which impacts productivity. More comfort-oriented features in MRI machines do make a difference for many patients, particularly for those with high body mass index (BMI) or claustrophobia. However, comfort in and of itself is not the only answer. For some tests, it will be uncomfortable and while we can do things to try to make it as easy as possible for the patients to get through the exam, there will be discomfort and there’s no way around it. So, to me, the term “comfort” and the importance of it, must also be combined with communication and support from the staff to get patients through the discomfort of the exam.
For example, with adenosine stress imaging, we are putting somebody into a tight tube and we are giving them a drug that makes them feel like somebody is sitting on their chest. From my point of view, what really helps the patient is to give them a visual indication of how long they need to hold their breath. At the same time, we explain beforehand to the patient what is going to happen. We need to be honest with them and tell them, “Yes, this is going to be uncomfortable, but don't worry about it, we will guide you throughout the process very well, we are here with you, and you will get both visual and audio indication to support you on the length of holding your breath.” That type of comfort – combined with communication and trust - is actually helpful to the people, we have had very positive feedback on that.
Arjen Radder, Philips: That’s a great point and, there’s research that backs up what you’re saying about the need to support and involve patients throughout the entire exam process. In a recent MRI global study of 40 radiologist and radiographers globally, SuAzio Consulting found that MRI efficiency gains can be made by implementing a stronger patient focus and involving the patient more in the examination process. The survey also found that 45% of interviewees were not aware of technologies that can improve patient compliance, reduce rescans and minimize patient motion. This tells me that there’s still a lot we need to do in terms of awareness about the important link between MRI productivity and patient-centered imaging. Patients who feel comfortable and secure make it easier for staff to acquire high-quality images and that correlates to MRI efficiency and productivity key performance indicators (KPIs).
Dr. Christoph Juli, radiologist: Yes, that is correct. We are making tremendous progress on the speed of MRI scans and equipment but “patient factors” like comfort or communication that contribute to MRI scan efficiency are a bit more complicated as every patient is different, every exam is different and each technologist performing the scan is different. There are better ways to increase patient compliance and reduce the need for rescans. Hospitals and imaging centers should seek out MRI equipment and technology that can provide positive and active distraction, as well as procedural guidance, for patients. The other key aspect is training staff how to provide comfort, support, safety and communication for patients throughout the process to address the other subtle factors that impact the patient experience and compliance.
Arjen Radder, Philips: I couldn’t agree more on the need for positive and active distraction for patients with MRI exams. Using Philips Ambient Experience, patients can select a theme before entering the imaging room, offering a relaxing environment of their choice by projection of images, ambient lighting and sound. From the moment the patient is moved into the scanner, Ambient Experience In-bore Connect helps the patient feel comfortable, by providing directions like breath hold and time duration that you mention as being very important.
Arjen Radder, Philips: Let’s talk a bit about staff now in the imaging department. When you talk about the importance of investing in staff, we know training to use the equipment effectively and understand images is paramount but improving the staff experience and reducing staff burnout are significant concerns for hospitals as well. According to recent research by the Advisory Board Company, one of the key imperatives for radiology leaders is to limit turnover and burnout of their current workforce because of the tangible impact it has on quality, cost, productivity and the health of radiologists. In particular, declining reimbursements is one of the top four contributors to burnout. How do you see the issue of radiologist shortages and burnout impacting healthcare today and what strategies do you use to address it in your own role as a radiologist?
Dr. Christoph Juli, radiologist: I agree that it is an issue globally that affects healthcare. While there are some common global reasons such as radiologist shortages, there is also some specific ones to each hospital and each country. So the ways of solving radiologist shortages and burnout will be addressed differently. Artificial intelligence is one way we can help reduce burnout by using AI to reduce the mundane, time-consuming or routine tasks that are part of the job of a radiologist so they can focus their time on higher-level concerns.
In terms of reimbursements, that is a pressure we all are faced with in healthcare and it can be stressful. For example, the Swiss government has decreased our reimbursements significantly. So now we are using the new Philips Ambition MRI platform together with Compressed SENSE to shorten examination times to handle the higher volumes of patients as a result of the reduction in reimbursement. This enables us to continue to deliver great image quality, put the focus back on patients and ultimately, helps to reduce staff burnout.
Arjen Radder, Philips: Let’s talk a bit about total cost of ownership (TCO). You mentioned using our Ingenia Ambition, based on our fully sealed BlueSeal magnet, which enables more productive helium-free MR operations. BlueSeal technology is a leap in sustainability progress over most MRI scanners that feature magnets that are not fully sealed, allowing helium to escape. When helium escapes, it can result in lengthy and costly disruptions in MR services and makes hospitals somewhat dependent on a commodity with an unpredictable supply and price. How much of a factor is TCO and productivity in MR while driving sustainability for healthcare in general or Switzerland in particular?
Dr. Christoph Juli, radiologist: In healthcare today, everyone is concerned with return on investment, we have to be. Healthcare is a business and we have to look at it in that way just like every other business. We must justify the cost, return and value of capital equipment, partnerships and on-going services. In the radiology department, we focus on stable platforms and reliability to ensure we have almost no downtime apart from servicing. We also need a partner that will work with us and support us long-term so the focus is on outcomes and integration.
In terms of sustainability, the BlueSeal magnet in Ingenia Ambition that offers low helium consumption is quite impressive. In Switzerland, quench pipe freezing is a potential issue so the fact that Ambition offers a solution with no quench pipe, is very helpful. The compact system is also beneficial because it doesn’t require a high ceiling and allows the cooling unit to be placed in a small area. This gives us much more flexibility and increases productivity and ROI value long term. If you can only choose one magnet, Ambition is a great one to have in your hospital.
Arjen Radder, Philips: When we think about the future of radiology and try to predict the evolution of healthcare, accessibility is top of mind. You’ve mentioned that you would like to someday see MR scanners in large shopping malls! That view aligns with the idea that the “retailization” of healthcare is driving a whole new patient experience paradigm in which patients have more choices and want to be treated as individuals with divergent needs. Can you share more details on why you think this is important?
Dr. Christoph Juli, radiologist: My goal would be to have MR available to everybody and so we have to start thinking creatively about how to do that and meet patients where they are to make MR more accessible. This is especially important if we increasingly use MRI scanners for screening of common diseases such as heart disease. It’s all about convenience. If we can bring MRIs to shopping malls safely, efficiently and cost-effectively, and it doesn’t take much effort or time for patients to get a screening, then I think we increase our chances of getting more patients screened. And, if we can get more patients screened, we can be more successful in detecting disease earlier and people have a better chance at prevention which, will ultimately have a very positive effect on population health.
 SuAzio Consulting, MRI efficiency study, December 2017.
As Global Business Leader for MRI at Philips, Arjen Radder is responsible for driving market growth and advancing Philips’ position as a leader of MRI technology and customer-focused diagnostic imaging solutions. Previously, he worked in a variety of general management roles in the healthcare industry in the US, Europe, the Middle East and Asia. His most recent role was as CEO of Royal Philips in the Middle East and Turkey region.
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Dr. Christoph Juli, FRCR
Dr. Christoph Juli has 20 years of experience in the field of radiology. He has a specialist interest in Cardiac Radiology and has led the cardiac imaging service of the Imaging Department at Imperial College London for several years. For the last four years he has worked at Spital Uster Hospital in Switzerland.