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Recent technological innovations in MRI, such as the next wave in parallel imaging and motion correction techniques, have further reduced scans times and improved imaging quality. There has also been a re-imaging of the ambient environment of the imaging suite. Dr. Jim Pipe of Barrow Neurological Institute (Arizona, USA), and Dr. Chip Truwit of Hennepin County Medical Center (Minnesota, USA) discuss how these changes are transforming clinical practice and the patient experience.
“There have been a host of technological transformations, but the biggest change is that radiology has justly moved forward towards the value proposition of putting the patient at the center of care,” says Dr. Chip Truwit, Chief of Radiology and Chief Innovation Officer at Hennepin County Medical Center. “And that applies to the entire experience that a patient undergoes from the thought of planning an MRI, to the preparation of having MRI, to how they undergo the MRI, to how we deliver the message of the results of the MRI.”
In recent years, changes in healthcare systems and the constantly shifting economic situation have increased the emphasis on healthcare costs and have influenced purchasing and operating models in MRI.
The technological developments have been dramatic"
Sagittal PDw TSE
Voxel size 0.3 x 0.4 x 2.8 mm
Scantime 3:50 min
Ingenia 3.0T
mDIXON XD TSE - PDw (Water Only)
Voxel size 0.4 x 0.6 x 2.5 mm
Scan time 3:05 min
Achieva dStream 3.0T
A milestone in the advancement of MRI came with parallel imaging. The sensitivity encoding (SENSE) parallel imaging technique enables a reduction in scan times by a factor of two or more. [1] Since its original implementation, continuous improvement of the technique has increased its performance and now dS SENSE* allows greatly increased speed in the routine clinical setting. Faster image acquisition can also help decrease breath-hold times, resulting in reduction of motion artifacts and fewer motion- corrupted images. [2]
“Parallel imaging makes a huge difference in how well we can image the abdomen and parts of the body where there is a lot of motion,” says Dr. Jim Pipe, Director of Neuroimaging Research at Barrow Neurological Institute. “So I think for the clinician it really has helped to extend the scope of MRI. And it makes a difference for the patient experience; in the distant past a lot of abdominal imaging would require a patient to hold breath for a very long period of time. I think just being able to image faster, and maybe image more intelligently over a few respiratory cycles, has made the imaging exam easier on the patient.”
Axial mDIXON
Voxel size 1.6 x 1.6 x 2.5 mm
Scantime 0:11 min
Ingenia 3.0T
The reality is that we handle a lot more work than we used to"
Axial T2w MultiVane XD
Voxel size 0.6 x 0.6 x 4.0 mm
Scantime 2:00 min
Ingenia 3.0T
Sagittal T2w MultiVane XD
Voxel size 0.7 x 0.7 x 3.0 mm
Scantime 3:37 min
Ingenia 3.0T
The volume of MRI scans performed has increased dramatically during the last decade. A study performed within large integrated healthcare systems in the USA revealed a 10% annual increase in the use of MRI during the period 1996–2010. [3]
In addition to increased patient numbers there have also been pressures from the changing patient demographics within society. A recent survey has suggested that the prevalence of obesity in the USA increased by more than two percentage points between 2008 and 2014, to 27.4%. [4] In an already aging population, the greatest obesity rise was seen in people over the age of 65.
“Simply increasing efficiency has been one of the major focus areas in the last decade,” Dr. Pipe explains. “A lot of the advances that I see are not just new applications but rather aiming to make applications more robust and collect data more cost-effectively. So, things like faster scanning have in my mind been some of the more substantial advances that we have seen in MRI.”
Are there efficiency gains from getting more information from a single scan? For instance, the mDIXON method that allows to get four contrast types from a single scan? “If you need two to four contrast types, then the ability to collect them all in one scan can lead to huge gains,” says Dr. Pipe. “You can shorten scanning time, and you can have the two pieces of information collected at the exact same time. That allows you to compare images side-by-side and be certain that the different features correspond to each other across the different types of contrast because there can’t be any motion in between. I think that can be very helpful. Also, isotropic scanning is a way that allows to view this information in multiple planes.”
Technological advances in the modern imaging suite have also led to efficiency gains"
“Technological advances in the modern imaging suite have also led to efficiency gains.”“Technological advances in the modern imaging suite have also led to efficiency gains.”“Technological advances in the modern imaging suite have also led to efficiency gains.”
“Technological advances in the modern imaging suite have also led to efficiency gains,” says Dr. Truwit. “With the conversion to PACS-based Radiology departments, we have seen a dramatic increase in the volume of scans that we can read in a day. Just by not having to physically hang a film but simply clicking on the next one saves time; having the prior studies immediately available saves time and helps to deliver quality in radiology care. Coupling these changes with communication tools to enhance critical results reporting, image sharing for second opinions ‘on the fly’, and regular peer reviews have all raised the bar in radiology.”
“Likewise MRI scanners have allowed for improved throughput. Because of parallel imaging and other changes, such as MultiVane XD** for motion-free imaging, we can perform scans in a shorter period of time. This frees up time to deal with the patient experience. But it also means that we can scan more patients while giving everybody the attention they need.”
I think the total cost of ownership is becoming a much bigger driver these days"
“The fast pace of technological development also has a potential impact on the decision-making process surrounding MRI equipment purchase,” says Dr. Pipe, “Scanners are a bit like computers in the sense that they don’t stay state-of-the-art for very long after buying them. I think the total cost of ownership is becoming a big driver these days. So, having the long-term view is important and upgradability is certainly an important factor."
“The length of time that hospitals keep MRI scanners has stretched a bit,” says Dr. Truwit. “Upgrading a scanner – as opposed to buying a new scanner – is of great appeal to many facilities, especially when one factors in the siting costs related to replacement. Upgrades provide the latest technology without having to buy a whole new scanner. Fewer dollars over a longer period of time, rather than recapitalizing. I think the question of total cost of ownership should be present in everybody’s mind when making these purchases.”
“For a patient who is trying to heal, we want to offer a healing environment,” says Dr. Pipe, “I think having an MRI exam is one of the more stressful experiences for a patient while in hospital. Anything we can do to reduce that stress is really good. I see an increasing awareness of the importance of the patient experience. Keeping the stress on them as low as possible is important.”
For patients who experience feelings of helplessness, entering the bore of the scanner can be a quite stressful moment. This led vendors to investigate solutions to make the patient more physically and emotionally comfortable when entering the scanner room and while inside the scanner. These ranged from reducing the distressing level of noise, to providing in-bore entertainment to distract the patient while the scan is proceeding.
There are very few patients that we can’t scan successfully with our very short sequences now"
“The increased speed of imaging has also had definite benefits for the overall patient experience, and particularly in scanning difficult patients,” Dr. Truwit says. “There are very few patients that we can’t scan successfully with our very short sequences now. It might not always be a perfect scan in the very difficult patients, but it’s diagnostic.”
“I think for the patient the experience of being in that MR scanner for a much shorter period of time is a big deal,” says Dr. Pipe. “And just anecdotally, I would say that the faster we can get a patient in and out of the scanner, the less chances there are that the patient is going to become agitated or worried and starts moving around and becoming less compliant. We are interested in looking at how we can get the patient in and out of the scanner in a fast enough time so that they will lie still and we can collect high quality data.”
[1] Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P. SENSE: sensitivity encoding for fast MRI. Magn Reson Med. 1999;42:952-62.
[2] Deshmane A, Gulani V, Griswold MA, Seiberlich N. Parallel MR imaging. J Magn Reson Imaging. 2012;36:55-72.
[3] Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, Greenlee RT, Kruger RL, Hornbrook MC, Roblin D, Solberg LI, Vanneman N, Weinmann S, Williams AE. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA. 2012;307:2400-9.
[4] Levy, J. U.S. obesity rate inches up to 27.7% in 2014. Gallup US Obesity Rate
**MultiVane XD provides improved motion correction (motion-free) compared to standard TSE and shorter scan times compared to MultiVane thanks to the compatibility with dS SENSE.
Innovation Matters delivers news, opinions and features about healthcare, and is focused on the professionals who work within the industry, as well as Philips as a cutting-edge health technology organization. From interviews with industry giants to how-to guides and features powered by Philips data, our goal is to deliver interesting, educational and entertaining content to empower and inspire all those who work in healthcare or related industries.
Chief of Radiology and Chief Innovation Officer of Upstream Health Innovations at Hennepin County Medical Center, Minnesota, USA, and Professor Emeritus of Radiology at the University of Minnesota
Specialist in neuroradiology with clinical interests in pediatric neuroradiology and intraoperative MR-guided therapy.
Chief of Radiology and Chief Innovation Officer of Upstream Health Innovations at Director of Neuroimaging Research at Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
Wide professional and research interests, including novel acquisition and reconstruction methods, fast scanning, and improving MR value.
April 12, 2019
