The imaging implant conundrum: scanning safely and efficiently

December 05, 2018
By Lawrence N. Tanenbaum

In a busy imaging operation, it is critical to be efficient, on schedule and patient-centered.
One situation that can paralyze your operation is the unexpected finding that the patient you are about to scan has an indwelling implant.

Over the past several years, medical implants have advanced greatly, becoming smarter, safer and increasingly prevalent due to a rise in chronic conditions and overall advancement of surgical outcomes. Our growing senior population is expected to need an increasing number of MR scans due to conditions such as neurodegenerative conditions, cancer and musculoskeletal diseases. Today, approximately three million people have implanted medical devices and due to our aging population alone, this number is expected to grow by almost 70 percent by 2020.

This is a concern for imaging operations. Implants create a challenging circumstance with limitations on safe scanning conditions that must be carefully considered. Researching the nature of devices in the course of a busy schedule can be deleterious to workflow. Obtaining critical information on the nature of the implant can be time-consuming. Sources about implant requirements such as are an invaluable and highly efficient resource.

Understand the impact on productivity and the patient experience
Implants generally fall into three categories, MR safe, MR conditional, or MR unsafe. While patients with MR conditional implants can undergo scanning safely, it must be done within clearly defined guidelines by well-trained MR staff armed with the appropriate information. Rigorous pre-screening routines must be in place to identify patients with implants, ideally, before they show up for their MR examination appointment. Unfortunately, imaging center staff regularly learn of implants as a patient shows up for the scan, and may not have the critical information immediately on hand – leading to inevitable delays and patient inconvenience that propagates through the rest of the scanning schedule.

Use technology to facilitate confident and safe scanning
Even with all the information about implant conditions at hand, the process of prescribing scan variables within the appropriate limits is typically done manually and often indirectly for each individual scanning sequence the patient requires - a process that requires significant expertise and is inevitably highly time-consuming and thus, inconvenient for the patient. The potential for error with multiple entries and manual adjustment is real. Fortunately, there are solutions.

Innovative scanner software, such as Philips ScanWise Implant MR, allows the operator to directly enter the implant manufacturer’s prescribed limitations for scanning parameters one time at the onset of scanning. Once set, the conditions propagate automatically and consistently to all scanning sequences. Regardless of the level of staff experience, automated guidance unique to each implant allows each technologist to scan the patient with confidence. This type of tool is simplifying workflow, but also enhances peace of mind for the supervising radiologist and referring doctors.

Focus on patient-centered care
The MR scanning experience is more time-consuming than that of other modalities such as CT, and the scanner’s restricted space can provoke patient anxiety in almost 30 percent of exams. The more a scan is prolonged due to a technologist’s need to confirm parameters, the longer patients are in the scanner and the more uncomfortable and stressed they can become. Immersive, and distracting enhancements to the scanning environment such as Ambient Experience can enhance patient comfort during the exam, and technologies such as Compressed SENSE can help shorten exam time significantly.

Concerns over scanning patients with implants can impact timely diagnoses and treatment. Patients with MR conditional implants may have easier access to safe MR over the next decade, as advanced technologies make these types of scans easier to perform and more comfortable. As more and more people with conditional implants present for MR scanning, imaging facilities need the appropriate skills and tools in place to scan with confidence and efficiency, converting adversity into practice opportunities.

Lawrence N. Tanenbaum
About the author: Dr. Tanenbaum is currently a VP and director of Advanced Imaging at Radnet Inc. since 2015, coming from Icahn School of Medicine at Mount Sinai in New York where he attended in Neuroradiology and served as an associate professor of Radiology, director of MRI, CT and Outpatient / Advanced Imaging Development since 2008. Prior to that he spent over 20 years in the private practice of Radiology at the JFK Medical Center / New Jersey Neuroscience Institute as Director of MRI, CT and Neuroradiology.