PERSPECTIVES THE VALUE OF HIGH-FIELD OPEN MRI

Neuro Imaging and Beyond

How High-Field Open Suits Value-Driven Medicine

SPONSORED BY HITACHI HEALTHCARE AMERICAS NEURO IMAGING AND BEYOND: HOW HIGH-FIELD OPEN SUITS VALUE-DRIVEN MEDICINE

By Dr. Lawrence N. Tanenbaum

Figure 1 — Oasis efficiently images the brain at 1.2T, using 3D isoFSE FLAIR (isotropic) to produce high-field, quality images (top row), along with T2 FSE, DWI and T1 axials (bottom row).

ith patient-centric and that are ever shorter, cost less to perform, value-driven medicine, and are less taxing to interpret. Efficiency the role of radiologists is is critically important in view of reduced evolving. Increasingly we reimbursements and heightened patient are called on not just to expectations. Even minor differences in Wdiagnose but to also organize information scan times can change patient perceptions necessary for medical decision-making of the care they have received and and patient management. impressions that we have documented in In this challenging environment, we patient surveys at RadNet facilities. must look for ways to deliver consistent In addition, our goal is to brand and reproducible high-quality and consistency and excellence, so that accurate images generated through exams referring physicians are assured and

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Figure 3A & B — Shoulder imaging poses a particularly difficult challenge, but RADAR cleans up respiratory and somatic motion artifacts, making scans easier to interpret and more reproducible. Figure A was acquired without motion compensation. Figure B was acquired with RADAR motion compensation.

Figure 2 — Oasis FatSep can deliver four images with different contrasts in a single scan. First column FatSep sagittal; second column FatSep coronal; and third column T1 axial (top) and T2 fat sat axial (bottom). This knee scan was completed in about 12 minutes.

confident that the MR exam we perform when scanner field strengths were no This is evident in Oasis scans of the brain as image review. Standardization reduces knee and shoulder exams. Optimized FSE FAT SUPPRESSION will be top-notch regardless of the site or greater than 0.3T. well as other body parts. variability and, consequently, reduces (opFSE) sequences, built into QuickScan, Few innovations save as much time as exam type—brain, spine, abdomen, pelvis, The Hitachi Oasis, which we operate at But the benefits of the high-field open callbacks, which patients resent. deliver uniform high-resolution images Dixon-based fat and water separation extremity, vascular or cardiac. multiple RadNet sites, operates at a 1.2T scanner extend beyond image quality, Among the scanner-based tools that with enhanced image clarity and techniques. Leveraging chemical shift, At RadNet we strive to perform magnetic field. But in various applications, providing comfort for anxious patients boost workflow and improve accuracy sharpness, and reduced scan times. these sequences­—first proposed in the MR exams consistently across our more particularly musculoskeletal, Oasis owes who might not otherwise be able to are two—Intelligent Parameter Guidance Oasis’s 3D isoFSE (isotropic) allows us to mid-1980s—use in-phase/out-of-phase than 300 facilities, preferably with similar its clinical performance to more than just tolerate an MR exam. The 82 cm-wide and Image Quality Indicator—that give add value by providing additional planes cycling of fat and water to uniformly protocols to generate reproducible and field strength. Its openness provides the table supports patients weighing up to technologists real-time assistance during of interrogation without adding scan suppress the signal from fat. This can be a reliable results. We focus on innovative ability to move the patient to isocenter 660 pounds. scan setup. AutoPose and Copy Drive time. Instead of performing a FLAIR scan huge time saver. techniques and technologies, including and the magnet supports advanced higher Addressing patient needs is crucial in boost consistency by automatically in the sagittal and axial plane as we once Combined with sequences such machines and pulse sequences that allow order multi-directional field shimming to value-driven medicine, as is efficiency. positioning slices from sequence-to- did, we can now produce three planes of as Fast Spin Echo, Gradient Echo and us to work efficiently and derive the achieve uniform fat suppression and large Nothing hampers the success of an sequence. MIP and MPR tools quickly interrogation in a single scan. (3-D FLAIR Steady State Free Precession, Oasis greatest value, while keeping patients first field-of-view. A large complement of coils MR operation like a cancelled scan or generate high-resolution image reformats; takes about five minutes versus between FatSep delivers—in a single scan— in mind. supports high-performance imaging of any a callback. Standardization factors into diffusion weighted imaging and apparent eight and nine minutes for two 2-D scans.) four images with different contrasts. body part. Together these technologies overall efficiency and quality of care, as it diffusion coefficient mapping are 3D produces beautiful high-field, quality For example, we used two FatSep HIGH-FIELD OPEN allow Oasis to produce routine high-field can lead to shorter and more value-driven automatically generated. images that leave nothing to be desired sequences, each spanning just more One of these innovations is open MR. images comparable to those of traditional, and more consistent exams. We are particularly proud of the (see Figure 1). This efficiency can come in than four minutes, to produce four Its underlying technology and the cylindrical 1.5T scanners. In so doing, Referring physicians appreciate QuickScan protocols (developed by handy especially in pediatrics, for example, images of the knee. The whole knee scan clinical results that can be achieved have Oasis maintains image quality standards standardization assuring the examination RadNet in collaboration with Hitachi) when you’re trying to finish the scan was completed in about 12 minutes on changed radically since the early days established by these high-field systems. will meet their needs and facilitating their which produce high-quality brain, spine, before a child’s tolerance expires. the Oasis (see Figure 2). The 40 percent

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Figure 4 — Oasis routinely delivers gold-standard quality, definitive exams that reveal subtle pathologies in neuro patients.

reduction in scan time (PD and PD fat Shoulder imaging poses a particularly Even thoracic spine exams are not sat in a single scan) allows us to be a lot difficult challenge (see Figure 3A and particularly challenging on the Oasis. more customer-focused—and to stay on B). RADAR cleans up respiratory and Musculoskeletal images are excellent. schedule, which can be challenging. somatic motion artifacts (see Figure 3B), High-field abdominal and pelvic exams are At RadNet, we assign 30-minute slots for making scans easier to interpret and routine, including dynamic multi-phase each of our MR exams—even those on more reproducible. abdominal imaging; diffusion-weighted IMAGING the high-field, open Oasis system. With Open MR systems have always been imaging; single shot fast spin echo; 5 Columbus Circle (1790 ) approximately 15 minutes of diagnostic patient-friendly, but early generations in- and out-of-phase gradient echo. MRCP Lower Level and 9th Floor image acquisition, this allows enough could not deliver high-field image (MR cholangiopancreatography) studies New York, NY 10019 time to transition patients and provides quality. These low-field open scanners deliver superb clarity; RADAR in pelvic Website: www.radnet.com/new-york- a buffer of time whenever things don’t produced images that pale in comparison imaging eliminates motion artifacts. We radiology-partners/locations/ go as planned. FatSep techniques are to what can be achieved today on the perform cardiac, breast, even prostate columbus-circle-imaging routinely used for brain and spine scans, Oasis, which produces high-field images studies in patients who must avoid as well as for the extremities. for any type of exam. Unlike closed 1.5T cylindrical systems. Repeat scans are devastating to scanners, however, Oasis meets the productivity and hard on the patient. challenges of anxious and large patients. VALUE-DRIVEN MEDICINE OVERVIEW OASIS KEY BENEFIT KEY QUOTE Fat separation techniques are remarkably To get these patients in an MR scanner— In the end, what matters in this value- Columbus Circle Imaging is a partnership While suited particularly to the needs “Answering the comfort needs of resistant to fat suppression failure, even and get a high-quality, high-field exam— driven era is producing high-quality, between New York Radiology Partners and of large patients and those fearful of patients who want this; the clinical around metallic implants. is a big deal. diagnostic studies efficiently and cost- RadNet, a major U.S provider of outpatient tight spaces, many of the scans done at needs of patients who need this; and Motion can affect about one-third Most Oasis patients in RadNet surveys effectively, while providing a comfortable imaging services. The outpatient center, Columbus Circle Imaging assess the brain requirements of the doctors who order the of scans we perform. RADAR motion rate their in-scanner experience as having patient experience. Our investment in located near NYC’s , provides and spine. But, according to Dr. Lawrence examinations, is really the essence,” said compensation, which enables modified been “better than expected.” This is a big Oasis delivers this.  advanced imaging including PET/CT, 3-D Tanenbaum, a neuroradiologist by training Tanenbaum, who is also vice president radial acquisitions, limit motion artifact success for us, because these patients mammography and high-field open MRI. who directs CT, MR and advanced imaging and medical director of RadNet’s Eastern for nearly every type of acquisition. don’t want to be in an MR scanner at all. at the center, Oasis is routinely used for a Division. “We can do all the key requisites.” About the Author: Dr. Lawrence Tanenbaum has RADAR covers a broad range of pioneered patient-centric and value-driven imaging wide range of everyday applications. sequences, including spin echo (SE), FSE, DEFINITIVE EXAMS for decades. In 2015 he became vice president and fast inversion recovery (FIR), balanced Oasis routinely delivers gold-standard medical director of RadNet's East Region and director of CT, MR and advanced imaging of the nationwide SARGE (BASG) and time of flight (TOF) quality, definitive exams that reveal subtle company, which operates more than 300 imaging MR angiography. pathologies, such as this small, en-plaque sites. Previously Tanenbaum served as director of RadNet uses RADAR routinely to planum sphenoidale meningioma (see CT, MRI and outpatient imaging at Mount Sinai in . He also spent nearly 20 years in the eliminate artifacts that would otherwise Figure 4). Spine studies maintain their outpatient setting of a busy community hospital appear in routine (Cartesian) techniques. quality even in the sickest of patients. system in New Jersey.

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