What should ICE Magazine readers know about MRI? Find out what some experts told us in this Director’s Circle article. Experts also shared knowledge about the latest features, money saving tips and more.
Participants in this month’s Director’s Circle on MRI are:
- Marty Ayres, RT(R)(MR), MRSO (MRSC), MRI Supervisor, University Hospitals Cleveland Medical Center
- Andrea Burt, RT(R)(CT)(MR), MRSO (MRSC), Imaging Manager, Outpatient Care New Albany, The Ohio State University, Wexner Medical Center
- Tobias Gilk, MRSO (MRSC), MRSE (MRSC), M. Arch., Radiology/MRI Consultant
- Kelsey Mach, Director of Imaging and Cardiology, CHI St. Luke’s Health Brazosport
1. What are some of the latest features to look for in MRI scanners?
Ayers: Assuming a fully capable package of software licenses and MRI coils, the features I look for are as follows: powerful gradients, high channels, acceleration and reconstruction techniques including AI, large scan range without coil repositioning and a dockable table. All of these elements combined will help result in the fastest, most comfortable exam experience for the patient. Manufacturers are also addressing patient comfort and claustrophobia concerns by making the bore of the MRI machines shorter and more accommodating (70 cm and 80 cm).
Burt: Artificial Intelligence being utilized to speed up MRI scans along with increasing image quality using AI technology. The ability to scan metal implants and get improved image quality with reduced susceptibility artifact. Lastly, 80-centimeter bores are becoming the new norm making MRI a game changer for patients with anxiety or claustrophobia about having the procedure.
Gilk: My focus is primarily on patient safety and patient access to MRIs (primarily for medical device patients who may have a hard time finding imaging providers that can effectively manage the particular risks for these patients). For decades most of the technical innovations for MRI have each incrementally ratcheted “up” the risks for patients. I’m super excited about the burgeoning suite of AI tools, however, that might be able to reduce the amount of power that we use for MRI imaging, reducing some of the risks to MRI patients. I’m particularly excited about MRI image de-noising tools, and potential AI contrast enhancement. These could appreciably increase patient safety for those being imaged on the systems that have these capabilities.
Mach: Faster scan times, which equal faster interventions for patients. In addition, the coils have more channels to better capture and image patients for more accurate diagnosis.
2. What are some money savings tips when it comes to MRI?
Ayers: With the ongoing and increased shortage of medical helium, machines that are smaller, lighter, and that have a helium-free infrastructure make a lot of sense. These machines are much easier to site because of their size and the fact that a quench pipe is not needed. This results in significant cost savings. Mobile MRI units also allow hospital systems to test out new markets with less siting concerns and less cost.
Burt: Before committing to purchasing an MRI unit, evaluate your patient population and service lines intended to use the services. Getting all the bells and whistles are not always needed if the organization doesn’t have the patient population or physician demand to utilize them. Focusing on the features that will benefit your organization will give you more cost savings in the long run. Evaluating your contrast usage and product being used for patient safety and high image quality can also be a long-term benefit.
Gilk: Don’t be “penny wise and pound foolish.” There are lots of ways to “pinch pennies” when buying MRI equipment, or planning the suite that will be the means of delivering the care. Keep in mind that planning cost is typically a fraction of construction cost, and construction cost is a fraction of equipment purchase (and service contract), and equipment cost is a fraction of the revenue potential over an anticipated 10-year life of an MRI scanner. Don’t go around spending money like a drunken sailor, but also don’t be afraid to invest in maximizing your capabilities to take care of a greater number and variety of patients for a decade or more.
Mach: One cost savings tip would be to make sure that your charge master is current and that each referring physician has an updated copy of all exams offered by the hospital with a fee schedule. I would also send a Survey Monkey to the physicians yearly to see if new exams can be added to accommodate new treatment options for patients.
3. What are some important safety measures everyone should know when it comes to MRI?
Ayers: Lots to talk on here (identification and signage for MRI Zones, proper labeling of equipment, designation and training of MR personnel, etc). I’ve chosen to focus on proper patient preparation. With most clothing being manufactured with the use of metallic snaps, buttons, fasteners or potentially having metallic fibers woven in, all sites should implement a MRI change policy where all patients are asked to change out of street clothes and given slip resistant footwear in place of shoes. This helps to eliminate the projectile risk from any items possibly left in the patient’s pockets or otherwise and the burn risk from the metallic fibers. All other metals and electronics should be removed and secured at the time of changing. As part of a “full stop and final check,” all patients should be thoroughly interviewed and rescreened for any contraindications and an ferromagnetic detector should be used to look for any magnetic items prior to the patient entering the MRI environment. Due to the acoustic noise generated by the MRI machine and the potential for hearing damage, the patient should be given proper hearing protection consisting of earplugs, headphones, or both depending on the noise reduction rating (NRR) of each.
Burt: MRI can be a very useful modality for imaging and diagnosing pathology. However, it’s strength is underestimated, and damage can occur to devices entering the suite. Having a stringent MRI safety program and following the ACR white paper with suite/zone structure will decrease your chances of a significant MRI safety breach along with annual safety and education training.
Gilk: The “lowest-hanging fruit” for most MRI providers is, in my opinion, to make sure your site has a named MRI safety officer (MRSO), a named MR medical director (MRMD), and a named/contracted MR safety expert (MRSE). For this you only need to allocate a handful of letters to existing individuals. Personal accountability is vital for many institutions to be able to see meaningful change happen. Beyond that, go through your written policies with a fine-toothed comb to make sure that they’re complete and that they agree with both how your site actually practices, and industry best practice documents, like the ACR Manual on MR Safety.
Mach: One safety measure that I like to remind my employees about is complacency. When dealing with the MRI you must never let your guard down for anyone. This includes other employees. The staff needs to be trained yearly in MRI safety and the MRI tech should screen every single person that steps foot into the suite.
4. What role do you see AI playing in MRI?
Ayers: AI allows faster reconstruction of MRI scans and the ability to improve both the sharpness and resolution of the MRI images. This results in a significantly shorter exam time for patients with no sacrifice to image quality. Facilities will be able to accommodate more patients with shorter exam times and backlogs will be greatly reduced or non-existent. AI will also be used to help with the interpretation of images and provide a more accurate and timely diagnosis which will result in better patient outcomes.
Burt: AI is playing a huge role in MRI currently, offering increased resolution and increasing the speed of acquiring images. I foresee AI being the technology that aids in fast-tracking MRI efficiency.
Gilk: MRI scanners are really sold on two different features … how pretty the pictures are that they make, and how quickly they make those pictures. The AI tools that are on today’s scanners continue to work on those twin primary selling points, but they have some collateral (probably unintended) safety benefits. When we can start applying AI tools to MRI safety (for example, identifying/recording the presence of implants/foreign bodies from visual analysis of prior films, or aggregating implant/device data from across different patient data platforms to present a pre-populated patient risk-profile for the newly scheduled MRI patient), I expect we’ll see some pretty remarkable leaps forward for patients with good EMR histories.
Mach: AI is going to help improve the efficiency and accuracy of medical imaging especially in MRI.
5. What else should ICE Magazine readers know about MRI?
Ayers: MRI has come a long way in a short period of time. Manufacturers have made great strides in addressing the shortcomings of MRI technology. Through new innovations, they continue to improve patient’s perceptions of these exams. People used to think of MRI as lengthy exams where you had to lay on a table in a long and dark tunnel while listening to loud noises. MRI machines today are created with much shorter bores having larger openings and with the ability to acquire sequences much faster. In some cases, these reduced scan times have the ability to mimic CT or X-ray. Vendors have also addressed the noise concerns of MRI by creating the ability to acquire quieter or completely silent MR sequences.
Burt: Having a robust and ongoing patient and staff education can go a long way to improving patient experience, departmental safety, optimal image quality and best practices. A hidden gem for MRI that works well once staff are properly trained is Comfort Talk, a way to ease the minds of patients who are claustrophobic or have anxiety without the use of medication.
Gilk: Today, 2024, MRI safety is almost entirely unregulated and ungoverned … this is true of state licensure, accreditation and even federal conditions of participation. This means that MRI safety responsibility (read: legal liability) falls almost exclusively to the radiologist, the hospital or imaging center, and the technologist. Today you really can’t point to your license, or state inspection, or a passed accreditation survey as any sort of demonstration that your site adheres to the minimum standard of care for MRI safety, let alone industry best practices. The individuals and institutions are really the ones who need to identify the risks and develop a set of standard practices to effectively manage those risks. None of the organizations that typically promise “quality and safety” actually provide structure or guidance for the providers. For right now, you’re on your own and you have almost total responsibility.
Mach: While MRI is a great machine to diagnose patients, it can be deadly if the technologist is not properly screening the patients.
