Justin Glavis-Bloom1, Brian Yep1, Lu-Aung Yosuke Masudathaya1, Jennifer Soun1, Edward Kuoy1, Lori Norrick1, Sara Stern-Nezer2, Wengui Yu3, John Fox4, and Daniel S. Chow1
1Radiological Sciences, University of California, Irvine, Irvine, CA, United States, 2Neurology & Neurological Surgery, University of California, Irvine, Irvine, CA, United States, 3Neurology, University of California, Irvine, Irvine, CA, United States, 4Emergency Medicine, University of California, Irvine, Irvine, CA, United States
Synopsis
Point-of-care, bedside MRI represents a promising new technology for imaging emergent and critical care patients. Whereas in the past, resources were needed to assemble teams that
included critical care nurses, respiratory therapists, and transport teams to bring
patients to and from radiology departments, there is a dramatic reduction in
personnel for POC imaging. This feature was especially important during the
COVID pandemic to improve availability of our respiratory therapists and nurses. More studies are needed in the future to ascertain its diagnostic sensitivity and specificity for neurologic findings.
Introduction
For patients
with acute neurologic pathologies, early diagnosis and aggressive management
may prevent aggravated or secondary injuries, thereby reducing mortality,
morbidity, and healthcare costs1, 2. Diagnostic imaging with MRI is important in these
patients when neurologic examinations are unattainable due to impaired
consciousness3. Unfortunately, acquiring diagnostic
brain MRIs for critical patients in intensive care units (ICUs) remains
challenging, especially for patients who are often too medically unstable to
transport. This feature was especially important during the COVID-19
pandemic given the surge of critically ill patients. One potential solution
includes novel, bedside or point-of-care (POC) MRI, which has recently received
Food and Drug Administration (FDA) approval (Hyperfine, Guilford, CT)4. This study shares our initial
experience with a novel bedside MRI.Methods
This is a retrospective observational series of patients who
received a portable MRI at the University of California, Irvine from January
2021 through March 2021. We evaluated the number of cases from both Emergency Department
(ED) and Intensive Care Unit (ICU) settings and descriptively report the number
of diagnostic and nondiagnostic studies. For those with concurrent MRI with a
fixed 1.5 tesla or 3.0 tesla MRI, we report whether new findings were observed.
Lastly, we compared turnaround time (TAT), defined as time to order to study
completion, of the POC MRI to our fixed MRIs.Results
In total, POC MRI was conducted in 19 patients (7 ED and 12 ICU
patients). Of the 19 MRIs, 17/19 (84%) were felt to be diagnostic. Of 8
patients who had a concurrent fixed MRI, 3/8 (38%) had a new finding. This
included 2 patients who had initial nondiagnostic scans and 1 patient who had a
6 mm right thalamic infarct. Operationally, the TAT for acquiring a POC MRI
was significantly faster compared to fixed MRI in both ED (2.9 hours versus 6.4
hours, p = 0.03) and ICU settings (9.2 hours versus 25.8 hours, p = 0.007). For
ICU patients, this included 9 patients who were otherwise too unstable to bring
to the MRI, including several COVID-19 patients. Discussion
This initial pilot study demonstrates the initial the diagnostic
utility of POC MRI, which was diagnostic for most of our patients. Whereas in the past, resources were
needed to assemble teams that included critical care nurses, respiratory therapists,
and transport teams to bring patients to and from radiology departments, there
is a dramatic reduction in personnel for POC imaging. This feature was especially
important during the COVID pandemic to improve availability of our respiratory
therapists and nurses. In addition, we demonstrate operational improvements in
POC MRI utilization. Acknowledgements
No acknowledgement found.References
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