Ali B Syed1
1Assistant Professor, Stanford University, Palo Alto, CA, United States
Synopsis
Diffusion weighted imaging (DWI) has critical applications in many clinical contexts, and as its utility continues to increase, new techniques for improved image quality are coming to the clinic. This session will discuss best practices and strategies for taking new, exciting developments in DWI and applying them in a clinical setting. The presented framework highlights key points to consider when implementing new techniques in the workflow of a busy practice.
1. Piloting
a. Determine applications where DWI can provide valuable clinical information
i. Growing applications throughout the body, particularly in body imaging and musculoskeletal imaging
1. Abdomen and pelvis imaging for tumors, inflammation, etc
2. Pelvic imaging particularly prostate and rectal imaging
3. Musculoskeletal imaging
ii. Define the scope of initial goals – which clinical indications, protocols, goals
b. Try it out!
i. No substitute for real-life trials
1. Phantom trial
2. Volunteer trial
ii. Identify a technologist (and possibly radiologists) to work with
iii. Often easiest to implement on one protocol, one scanner to start
1. Need a contact point for when things don’t go as planned
iv. Iterate, iterate, iterate
1. Free-breathing versus breath-held
a. Respiratory Triggering, Navigation, Averaging
2. Multi-shot DWI methods
3. Optimize b value and spatial resolution
4. Vendor improvements: de-noising, distortion correction, etc.
2. Prime Time
a. Re-visit protocols with new information on hand
i. How much will it help?
ii. How often will it help?
iii. How much time does it take?
b. Implement pulse sequence into protocols
i. Propagation to correct protocols – helps to have a procedure
ii. Technologist education – how to prescribe, helpful tips, what to change, what to leave alone
iii. Post-processing needs: ADC map generation
c. Radiologist education
i. How to use DWI
3. Keeping the Lights On
a. Solicit feedback early and often
b. Implement a QA/QI process
i. Constant messaging is key
ii. Maintaining quality is an active process, even if imaging technique is not changing
iii. Save examples that were particularly good quality or clinically impactful
Acknowledgements
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