What we’ve seen in our preliminary studies is that we can detect acute infarct on some of these patients that are undetectable on CT.
Edward Kuoy, MD, second-year attending neuroradiologist in the UC Irvine Medical Center (UCIMC) radiology department, knows first-hand the challenges associated with transporting ICU and ED patients to the radiology department for an MRI study.
When UCIMC acquired a shiny new point-of-care (POC) MRI scanner, Dr. Kuoy saw an opportunity to explore both the clinical and operational impact of the 0.06T portable magnet, which is FDA 510(k)-cleared for neuroimaging. He was awarded the 2021 SR-RSNA R&D Foundation Research Grant to kickstart his research.
“I believe we are the first academic institution on the West Coast to adopt this portable MR technology,” Dr. Kuoy said. “The nice thing about it is that at this field strength, it’s a permanent magnet that is always on, that does not need to be cooled down, and it can be maneuvered around the patient’s room in the ICU and the ER.”
Furthermore, the technology can be used to image patients typically contraindicated for MR. “Because of its low magnetic field strength, the 5 gauss line ends at the patient’s neck level,” he explained. “It is a fairly safe magnetic device even if the patient has a pacemaker or other device that terminates below the level of the neck.”
Matching Patients with Modality
Dr. Kuoy is taking two pathways in his investigation. The first is a clinical inquiry to assess which patients can benefit and the precise nature of the clinical pathologies that can be detected. “With any new technology, there will always be growing pains,” he said. “We are trying to find out how effective this device is, what lesions we can pick up, and at what size. We have left the discretion to order these exams entirely up to our neurology and emergency medicine physicians. Whether they decide to follow up this initial scan with a fixed MRI scan is also left entirely to their discretion.”
Most specialists are ordering the scans to assess for acute infarctions for stroke. This is what the UCIMC team anticipated because hemorrhage can be detected on a CT, which is quick and does not require the triage protocols to determine which patients are safe to be imaged with MR.
On the other hand, acute infarct is hard to detect early on CT, and even that may depend on subtle findings.“Depending on size and age of the stroke, you may not be able to detect it on a routine CT exam,” Dr. Kuoy notes. “What we’ve seen in our preliminary studies is that we can detect acute infarct on some of these patients that are undetectable on CT. There are a few issues depending on the patient condition, so we are trying to assess the optimal patient condition, what type of patients can be scanned, what types of pathology can be seen, and what sensitivity we can obtain.”
The scanner is 55 inches tall, weighs 1,400 lbs., and is transportable on wheels. “Because this is a new device, and there are not many publications at this point, that is where the research grant funding comes in,” he noted. “We want to see how this technology fares in the detection of strokes, and, particularly, if location and size matter.”
Addressing ICU Time to Scan
The second pathway will explore the technology’s benefit from an operational standpoint. Dr. Kuoy expects the scanner to be of great benefit to patients in the ICU. “ICU patients come with their own issues in terms of getting them down to the MRI scanner,” he said. “Every institution will be different, but at ours, we have a dedicated floor on the basement level where we house our MRI scanners while the ICUs tend to be on the 5th floor or above.”
Furthermore, ICU patients typically require a team of people to transport them to the imaging suite, leading to imaging turnaround times of up to 11 hours according to some published reports. “Depending on the clinical status of the patients, complexity of medications the patient requires, and the availability of personnel including transport team, ICU nurse, and respiratory therapist that must accompany the patient, it can take hours before these patients get scanned,” Dr. Kuoy stated. “All of these factors must align for an ICU patient to obtain an MRI exam.”
Instead of waiting to assemble a transport team, the MRI technologist can take the point of care MRI scanner up to the ICU patient to perform a bedside exam. “It does take a long time to image these patients in the radiology department, particularly ICU patients that tend to be more unstable,” he said. “We have been able to cut our turnaround time for patients in the ICU by at least a third, and that is promising.”
Optimization: Clinical and Operational
Dr. Kuoy sees the dual approach as two sides of the same coin—in identifying the optimal patients and pathology for the technology, clinicians will gain confidence in the technology and in using it, improve imaging throughput and potentially shorten length of stay.
“Our two research goals are aligned—the operational impact on the institution as well as the quality of the scans themselves,” he said. “If we are able to show that these pathologies can be seen up to a certain point, our clinicians will feel more comfortable ordering the new scans—they do look different than our fixed MRI scans. As clinicians get more comfortable, they will order it more often, and it will improve our overall operational efficiency. We can get patients in and out more quickly, especially in the ER. We can discharge from the ER more quickly, or admit them more quickly, and cut down on that turnaround time as well.”
Dr. Kuoy is the second recipient of the SR-RSNA R&E Foundation Research Grant. His grant was one of 80 awarded by SR-RSNA R & E Foundation last year.
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