28 ms·

Being a neuroradiologist (at Karolinska in Stockholm, Sweden) I really love the idea of this and almost can’t wait to start doing comparative studies to find ho

by lijf 7y ago

Being a neuroradiologist (at Karolinska in Stockholm, Sweden) I really love the idea of this and almost can’t wait to start doing comparative studies to find how sensitive it really is. As I see it there are a couple of areas where it could be of tremendous use - first of course the (neuro) intensive care unit, where patients sometimes are to unstable to transport to the MRI, and where every transport is a potential risk for the patient, and where it can be very useful to find out whether they have ischemic lesions in the brainstem (which can be difficult to rule in/out on CT) or extensive diffuse axonal injuries, etc. Another area would be pediatric imaging, where it could be useful as a first imaging, ruling out larger lesions, possibly lessening the need for CT and decreasing radiation exposure, especially in the group approximately 1-4 years, who often need sedation to lie sufficiently still inside the MRI. Although at my institution the physicists have developed a ‘fast MRI’ (70 seconds), that gives reasonable resolution and contrast (T1,T2,T2*,DWI), and which we will try to implement in the group of patients who come to ‘try’ the machine (before deciding whether they need sedation or not). Also, the low field strength, 0.064T vs 1.5T or 3T, would most probably allow us to image patients with implants which are unsafe at normal clinical field strengths of 1.5 or 3T (would have to be verified though). For people interested in low field imaging the group at Athinoula A Martinos Center for Biomedical Imaging at Harvard has a homepage at https://www.nmr.mgh.harvard.edu/lab/lfi https://www.nmr.mgh.harvard.edu/lab/lfi

luddaite 7y ago
Will ER rooms need to be re-designed to accommodate bedside MRI? The ER at the hospital I work at already has special rooms for Gyn and Ophtho complaints so it wouldn't be that far fetched for there to be a room designed for Stroke code patients.
hliyan 7y ago
Thank you (and the grandparent poster). We (or at least I) love seeing more HN participation from insightful professionals from outside the tech industry!
radicalbyte 7y ago
The combination of the cost and accessibility look like a game changer for me, a lay-ish person. With such a device, do you need a Radiologist or other rare super specialist to actually read the images? Or can they be used by generalists? Will this turn brain MRIs into a tool comparable to the X-Ray scanner my dentist uses or the Ultrasound used by the midwives a dozen times during pregnancy? If so it looks like a game changer - something which will become a fixture in A&E departments everywhere.
- lijf 7y ago
  You are of course right about the cost and accessibility, low field not necessitating specific rooms or ‘no go’ zones, and presumably easy operation (controlled via iPad app) being very interesting with regards to increased availability of MRI scans(in Sweden the rate limiting step at the moment is usually the availability of trained MRI technicians). In my initial comment I mostly thought about some clinical situations in my current practice where it would be useful. Sorry if the following becomes a bit rambling. Reasonably there are a plethora of indications and given that these machines will be installed at the point of care (A&E, ICU, etc) and supposedly are safe to use on basically all patients, one can imagine that it will be used very frequently. Though in this case the scan-time (30 min + change) could become a limiting factor (but, given it’s price, I guess you could just buy more machines). The image quality is of course not the same as with a modern clinical system but it is most certainly good enough for a preliminary test, and may very well decrease the number of patients sent for a ‘normal’ diagnostic scan (though the opposite may also be true, if you see something unexpected in the images, or if there are artefacts which are difficult to interpret). As with the ‘fast MRI’ I referenced to earlier, my current idea would be that it can be used as an initial screening, but, as always, if the test is normal, but the clinical suspicion persists one would have to continue with other tests. Regarding whether the image should be read by a specialist or not, I am of course biased towards the specialist :) As I see it the main advantage of having the clinician interpreting the image is that they have ‘direct access’ to the patient, and can ask them specific questions based on the findings of the test. Though, time-utility wise it’s faster for a specialist to read a normal test. During med school I did a rotation at a primary care facility in the north of Sweden, in a municipality with 6000 inhabitants, located almost 2 hrs away from the closest hospital, the GP:s there read chest x-rays themselves at that time. Now the images are transferred digitally to the main hospital of the region and read by a radiologist. One can of course wonder whether it’s cost effective to train a large number of radiologists to read all the new studies which will be produced. My hope here is that computer aided diagnostic tools will increase the productivity of radiology specialists. My experience from working together with neurosurgeons and neurologists who are very good at reading images in general, is that they anyway prefer to consult us for the interpretation, (they would rather operate than become specialist radiologists). In my opinion the professionals at risk of being side-stepped are the general radiologists, and I think this is already happening as telemedicine makes it possible for smaller hospitals to pay for specialist readings on a per study basis. edit: regarding time utility, one would of course have to include the time it takes for the referring physician to write a request, and for the radiologist to write a report. And another advantage of having the clinicians read the image is that they have more information about the patient than they put in the request. So it’s also very possible that radiologists will not be consulted (depending on medicolegal circumstances and reimbursement systems etc.)

by lijf 7y ago

luddaite 7y ago

Will ER rooms need to be re-designed to accommodate bedside MRI? The ER at the hospital I work at already has special rooms for Gyn and Ophtho complaints so it wouldn't be that far fetched for there to be a room designed for Stroke code patients.

hliyan 7y ago

Thank you (and the grandparent poster). We (or at least I) love seeing more HN participation from insightful professionals from outside the tech industry!

radicalbyte 7y ago

The combination of the cost and accessibility look like a game changer for me, a lay-ish person. With such a device, do you need a Radiologist or other rare super specialist to actually read the images? Or can they be used by generalists? Will this turn brain MRIs into a tool comparable to the X-Ray scanner my dentist uses or the Ultrasound used by the midwives a dozen times during pregnancy? If so it looks like a game changer - something which will become a fixture in A&E departments everywhere.

lijf 7y ago
You are of course right about the cost and accessibility, low field not necessitating specific rooms or ‘no go’ zones, and presumably easy operation (controlled via iPad app) being very interesting with regards to increased availability of MRI scans(in Sweden the rate limiting step at the moment is usually the availability of trained MRI technicians). In my initial comment I mostly thought about some clinical situations in my current practice where it would be useful. Sorry if the following becomes a bit rambling. Reasonably there are a plethora of indications and given that these machines will be installed at the point of care (A&E, ICU, etc) and supposedly are safe to use on basically all patients, one can imagine that it will be used very frequently. Though in this case the scan-time (30 min + change) could become a limiting factor (but, given it’s price, I guess you could just buy more machines). The image quality is of course not the same as with a modern clinical system but it is most certainly good enough for a preliminary test, and may very well decrease the number of patients sent for a ‘normal’ diagnostic scan (though the opposite may also be true, if you see something unexpected in the images, or if there are artefacts which are difficult to interpret). As with the ‘fast MRI’ I referenced to earlier, my current idea would be that it can be used as an initial screening, but, as always, if the test is normal, but the clinical suspicion persists one would have to continue with other tests. Regarding whether the image should be read by a specialist or not, I am of course biased towards the specialist :) As I see it the main advantage of having the clinician interpreting the image is that they have ‘direct access’ to the patient, and can ask them specific questions based on the findings of the test. Though, time-utility wise it’s faster for a specialist to read a normal test. During med school I did a rotation at a primary care facility in the north of Sweden, in a municipality with 6000 inhabitants, located almost 2 hrs away from the closest hospital, the GP:s there read chest x-rays themselves at that time. Now the images are transferred digitally to the main hospital of the region and read by a radiologist. One can of course wonder whether it’s cost effective to train a large number of radiologists to read all the new studies which will be produced. My hope here is that computer aided diagnostic tools will increase the productivity of radiology specialists. My experience from working together with neurosurgeons and neurologists who are very good at reading images in general, is that they anyway prefer to consult us for the interpretation, (they would rather operate than become specialist radiologists). In my opinion the professionals at risk of being side-stepped are the general radiologists, and I think this is already happening as telemedicine makes it possible for smaller hospitals to pay for specialist readings on a per study basis. edit: regarding time utility, one would of course have to include the time it takes for the referring physician to write a request, and for the radiologist to write a report. And another advantage of having the clinicians read the image is that they have more information about the patient than they put in the request. So it’s also very possible that radiologists will not be consulted (depending on medicolegal circumstances and reimbursement systems etc.)