Radiographer's Perspective: Reduction of Imaging for Value in MRI
Emma Hornsey1

1Austin Health, Australia

Synopsis

MRI is of high diagnostic value but it is historically slow and expensive. Reducing imaging can diminish these obstacles and create value through access. Advances in technology and working smarter with existing resources can significantly reduce examination times. Improved access to imaging and better patient tolerance of examinations will see MRI become a front line imaging modality. As more patients benefit from quicker diagnosis, timely treatment and better outcomes the clinical demand for MRI will only continue to grow. The ongoing challenges within this field will be maintaining adequate levels of patient care and Radiographer job satisfaction

TARGET AUDIENCE

MRI Radiographers/Technologists, Radiologists, Referring Clinicians

OBJECTIVES

To identify what value is in MRI and where it can be added through reduced imaging. To describe how to achieve reduced imaging. To explore the impact of reduced imaging on the role of the MRI Radiographer and the patient.

PURPOSE

MRI has always been considered of high diagnostic value. Outstanding soft tissue detail and a lack of ionizing radiation make it the imaging modality of choice for the investigation and follow-up of many medical conditions. MRI image acquisition is historically slow. Lack of speed has restricted access to imaging and therefore the diagnostic value that MRI could provide for many patients. How can we add value in MRI?

METHODS

The simplest way to add value in MRI is to create greater access. Reduced imaging equates to more patients examined. There are two principle approaches. The first is technology to perform imaging faster. The second is to work smarter with existing equipment, technology and protocols to reduce imaging.

DISCUSSION

The push to speed up imaging has existed since the birth of MRI. Technology to achieve this has advanced significantly in recent years. Parallel imaging, multi-channel receiver coils, stronger field systems have been part of our clinical practice for some time. While these allow reductions in imaging times, most of facilities have used them to push resolution and imaging detail. The result is improved diagnostic value within examinations but not significant reductions in imaging times. Imaging Faster: While the desire for speed has co-existed with resolution, recent advances in technology are very much time focused. Increased computing power to reduce image reconstruction times and workflow automation have been a significant focus of all vendors. Touch and go protocols, automatic alignment software and anatomic recognition software are now standard on modern systems. Advances in image acceleration techniques, including multi slice image acquisition and compressed sensing, allow significant reductions in imaging times while maintaining high levels of resolution. The result is the ability to scan with significantly decreased examination times.

While gains in time efficiency are significant with advances in technology, they are also expensive. Not all sites will have the financial resources for immediate upgrades to the latest speed focused technology. This creates a need to focus on value by working smarter with existing tools. Work with Radiologists and clinicians to scan less. Identify over imaging - are all the sequences necessary? Create abbreviated protocols targeting specific clinical questions. Assess where parameters can be optimized for time saving while maintaining diagnostic quality images. Assess all facets of the service to create maximum workflow efficiencies. Identify workflow bottlenecks and create smarter models for bookings, staffing and patient flow.

Access is the key benefit of reduced imaging. Patients can benefit from quicker diagnosis of illness/injury, more timely treatment and better outcomes. Hospital admissions can be avoided or of reduced duration. Expense of unnecessary tests reduced and exposure to unnecessary ionizing radiation avoided. Shorter examinations improve patient tolerance reducing the need for sedation/anaesthesia in claustrophobic and paediatric groups. Increased revenue is a further benefit. This creates incentive for additional capital outlay to upgrade or replace existing equipment and to invest in additional services further enhancing value in both profit and patient access.

Improved access does not come without risk. Patient care will be more challenging in the high volume imaging setting. Will there be the time to provide adequate care? Patients with special needs could be disadvantaged with suboptimal imaging or worst case scenario denied imaging altogether. The MRI Radiographer has the potential to become deskilled by quick automated protocols and workflows. Trouble shooting skills may also decrease due to lack of interaction with protocols/parameters. Time pressured safety decisions may lead to patient risk or injury. A production line like work environment could lead to job dissatisfaction and stress.

The role of the MRI Radiographer is changing. Two tiers of technologists will evolve. A basic level designed to deal with volume scanning. A specialist level designed for complex imaging/challenging patients. While automation and standardization will benefit throughput for many examinations they will not account for all patient variables. The specialised MRI Radiographer will be a necessity.

CONCLUSION

The clinical demand for MRI will continue to grow. Advances in technology and working smarter with existing resources can reduce significantly examination times. Improved access to imaging and better patient tolerance of examinations will see MRI become a front line imaging modality. While this has the potential for countless patient benefits, maintaining MRI Radiographer job satisfaction and high levels of patient care will be an ongoing challenge in this high volume setting.

Acknowledgements

No acknowledgement found.

References

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Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)