The democratization of MR

September 17, 2021
Jane Kilkenny
From the September 2021 issue of HealthCare Business News magazine

By Jane Kilkenny

“Everything old is new again” is a mantra in the world of fashion. In medical imaging, however, the path forward doesn’t typically bend back into the past. Consider clinical magnetic resonance (MR) imaging. The modality debuted in the 1970s and rose to prominence in the 1980s at field strengths that were a fraction of the 1.5 Tesla (T) and 3T scanners that would dominate healthcare decades later. While scanners below 1T remained available as higher-field MR began to take hold, they were no longer considered the standard for optimal care and fell to medical imaging’s periphery. And with the bar for state-of-the-art clinical MR set even higher since the advent of clinical 7T, the concept of the mid-field MR scanner — a scanner below 1T — may seem like a dusty curio in 2021.

Yet counterintuitive as it may seem, revisiting the mid-field MR concept — and modernizing it significantly with recent high-tech innovations — could have the seismic effect of democratizing this imaging modality, bringing MR to healthcare providers and patients who have been unable to enjoy the full benefit of its capabilities.
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This idea may raise eyebrows initially. After all, the lower-field scanners of the past posed undeniable challenges, including a lower signal-to-noise ratio, longer acquisition times, and larger siting requirements. And more recent 1.5T and 3T MR scanners, with their advanced digital hardware and software technologies, address many of those challenges.

But the upfront and total life cycle costs of those higher-field MR scanners discourage adoption for some healthcare providers. And while refurbished 1.5T and 3T scanners are less expensive than their brand-new counterparts, they may lack some of the cutting-edge innovations that have made them so desirable in the first place.

Fortunately, equipment manufacturers can now migrate advanced digital hardware and software – including digital radiofrequency (RF) technology and signal-loss-reduction software – from 1.5T and 3T scanners to mid-field scanners at a cost that more providers can afford. And recent high-field scanners have also introduced improved workflow and productivity elements. These time-saving elements can offset the longer exam times historically associated with mid-field MR, and can help less experienced users acquire high-quality images more consistently.

Mid-field MR also may have significant clinical impact. Lower field strengths yield fewer distortion artifacts when imaging metal implants. This reduced distortion could permit clinicians to, for example, better assess soft tissue surrounding the implant to reveal fluid buildup or inflammation, fracture or loosening of the implant, etc. Also, while computed tomography (CT) may be the clinical gold standard for pulmonary imaging, pediatric patients or patients who receive ionizing radiation scans regularly could benefit from MR’s nonionizing properties — and reduced artifacts at the air/tissue interface potentially make mid-field MR a more realistic secondary option than high-field MR. The academic community is investigating some of these potential uses of mid-field MR, with promising early results.

Also, mid-field MR may provide manufacturers with greater design flexibility, potentially allowing for a wider bore. That wider bore would not only increase patient comfort, but it could serve as the foundation for a new generation of intraoperative or interventional MR scanners. Additionally, this design flexibility could reduce siting requirements, which could permit easier, less costly installation for mid-field MR than higher-field scanners. And reduced siting requirements, coupled with mid-field MR’s lower cost, could even bring MR closer to the patient by introducing it to the primary care office.

By revisiting this concept of mid-field MR and buttressing it with key innovations found on higher-field scanners, we can envision a tantalizing near-future for MR: one that ensures greater equity and image quality for healthcare providers, so that they may better serve patients.

About the author: Jane Kilkenny is vice president of magnetic resonance at Siemens Healthineers North America.

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