The utility of MRI is under pressure for a variety of reasons, but mainly driven by costs containment and lack of accessibility.
A number of measures will be needed to allow MRI to flourish in the clinical management domain. These include the use of more focused examinations, optimised timing of investigations and the increased efficiency of imaging departments will be a way forward to improve the value of MRI to a wider population.
This presentation will introduce some concepts on how to improve the value of MRI and use examples of areas where this is starting to impact clinical management and improve cost-effectiveness.
MRI is still considered a costly modality in most healthcare economics evaluations around the world. This doesn’t fully take into account the value of MRI in the context of patient diagnosis, patient management and treatment evaluation. Clearly, a field of tension exists between MRI and other modalities, such as CT or Nuclear Medicine options. Nevertheless, MRI is able to offer valuable information that may not be gained from other techniques, and could replace some of these techniques, thus allowing a reduction of radiation dose in patients. To enable greater access to patients, and thus reduce the per-examination costs of MRI, it would be useful to support a number of methods.
These include:
1. More focused and shorter protocols to limit time on the table. This will require a shift in referral and education of physicians, who cannot request “blanket” requests, but will require to focus on a particular clinical question. In addition, medicolegal adoption will be required, as these exams will not be as broad as what is currently performed, and will lead to a different pattern of findings (with likely fewer unexpected findings or with diagnoses that will remain undiscovered due to shortening of protocols).
2. Increased access. This will require novel approaches to hardware and software development, where cheaper MRI systems are developed in poorer countries, while different indications allowing more front line approaches can be put in place
3. Improving the patient experience. This will include a number of positive outcomes, such as greater examination speed, greater speed of obtaining answers related to clinical symptoms as well as reduction of costs to both insurer and co-pay by patients. This presentation will offer some examples of where these changes could be delivered relatively quickly, hopefully offering a way forward to develop more of these shorter, focussed examinations. These will include diagnosis of pulmonary embolism, fracture diagnosis, screening for liver malignancy in liver cirrhosis, breast cancer screening and stroke imaging.
I acknowledge the input of a large number of ISMRM members, who participated in the discussion regarding this topic. I further acknowledge support by SINAPSE (www.sinapse.ac.uk)
1. Lee VS. Annual Oration: driving value through imaging. Radiology 2017;285:3-11.
2. European Society of Radiology. ESR concept paper on value-based radiology. Insights Imaging 2017;8:447-454.
3. Rubin GD. Costing in radiology and health care: rationale, relativity, rudiments, and realities. Radiology 2017;282:333-347.
4. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIQualityMeasures.html (accessed 17 Dec 2017).
5. Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11:88-94.
6. Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology 2015;277:826-832.