Opening Minds to Open MRI
How do you acquire the high–field-strength open MRI unit of your dreams in a tough economy? Unless you had already budgeted a cool million before the economy tanked, it may be difficult. David Nelson, director of outpatient imaging for BayCare Health System, Clearwater, Fla, overcame his lack of comfort with open systems last year and did just that.
“We get the best of both worlds, and we can accommodate claustrophobic patients as well as patients who can’t fit into the closed MRI. We are definitely in a society where people are getting larger, and I don’t see that trend slowing down at all.” --Michael R. Foreman
It was a long time coming, since most open MRI magnets hovered around the 0.3T–0.7T range—a strength rating that Nelson believes is less than ideal. Nelson, who oversees multiple BayCare Health System locations throughout the Tampa region, says, “When I first got here in Florida, there was a 0.3T magnet on every other street corner. It probably took me 5 years to change the thought processes of the local community that open was not better, especially at the typical magnet strength. The only option we had for high-field imaging was a conventional unit. I have now gone from being the arch enemy of open configurations, however, to being an advocate of having open units in your portfolio.”
Erin Butler, RTR
The debut of the 1.2T magnet ultimately changed Nelson’s mind, motivating him to allocate precious budget dollars to the new OASIS™ high-field open MRI from Hitachi, Twinsburg, Ohio, which is currently the most powerful open system on the market. Prior to purchasing the unit, BayCare Health System’s top radiologist went to Cleveland to look at the equipment. At that time, no OASIS had yet been installed in the United States. Like Nelson, the radiologist was not a big fan of mid-strength magnets. The trip went exceedingly well, though, and it wasn’t long before BayCare Health System was on the waiting list for a July 2009 installation. The team at Saint Joseph Mercy Health System, Howell, Mich, got on the bandwagon in September 2008, in a move that has already led to almost 2,000 successful scans using the new unit. Erin Butler, RTR, is MRI service delivery leader at Saint Joseph Mercy Health System, a system with 30 facilities and 13,000 employees. She says, “We are now able to serve a patient population that we could not in the past, and we are doing that. Rather than having to reschedule patients, we are now able to proceed within our own facility.”
Jim Knauf
Many MRI veterans have endured the embarrassing task of telling obese patients that closed, conventional MRI units are just not adequate. For the most part, open systems eliminate this problem. “Sometimes, when patients and even physicians hear open, they anticipate wide open,” Butler warns, “but these magnets, regardless of the field strength, have a top and a bottom, so there are still some criteria for being able to fit between the top and the bottom.” Fortunately, these limitations are rarely a concern, and the open unit is usually perfect for obese or claustrophobic patients. “We get the best of both worlds, and we can accommodate claustrophobic patients as well as patients who can’t fit into the closed MRI,” Michael R. Foreman, MRI manager at Lakeshore Bone and Joint Institute, a private facility in Chesterton, Ind, explains. “We are definitely in a society where people are larger, and I don’t see that trend slowing down at all.” According to Jim Knauf, business line leader at Saint Joseph Mercy Health System, his department has been able to accommodate a patient weighing nearly 272 kg (600 pounds) on the OASIS with little difficulty. “We would never have been able to scan this patient prior to having the new open MRI unit,” Knauf says. As a general rule, about 10% of patients are claustrophobic, and a small percentage of those are so severely affected that even an open MRI is out of the question. For these patients, anesthesia is an option, although that is never ideal, due to safety issues. Knauf estimates that fewer patients at Saint Joseph Mercy Health System are requiring anesthesia—which he believes is a direct result of having the new system. While it’s been only six months since he started using his new 1.2T open unit, Foreman can’t help anticipating new developments on the horizon. Fortunately, new software can be added to the system, which helps to keep things up to date. “Any software changes, we get automatically,” Foreman says. “The software can change the gradient performance in the magnet itself, and can fine-tune it to make your scans shorter, and even make the images clearer—even though you are using the same strength magnet.” For facilities with the money and motivation to purchase a new open unit in today’s economic climate, Foreman recommends going with a manufacturer that strategically places its service people in areas close enough to allow for prompt service. With no in-house biomedical department at Lakeshore Bone and Joint Institute, Foreman has a service contract, and repair technicians can usually show up in less than 2 hours. At a cost of more than $1 million, Nelson says, the price of BayCare Health System’s new open 1.2T scanner was more than reasonable, and even slightly more affordable than most conventional, closed units. “It is unusual for a new release to come out with such a good price, and that was a result of the manufacturer trying to get a good foothold in the US market,” Nelson says. “I think the company came up with a price point that was attractive to both hospitals and outpatient centers. This is going to be a successful magnet, and other manufacturers are going to have to respond to it.” Nelson points out that it is useless to have a powerful new open machine if no one knows about it. With BayCare Health System’s new open 1.2T unit scheduled to open in July, the marketing team has swung into action with efforts directed at both physicians and consumers. Newspapers and billboards will be part of a marketing effort designed to capitalize on today’s assertive patients, many of whom are not afraid to say to their physicians that they saw a billboard and they want to try open MRI. Since many referring physicians are still under the impression that open magnets equal inferior images, it will probably be a tougher sell among physicians. With this in mind, Foreman hosted open houses designed specifically for area physicians. Using brochures and personal visits, Foreman has succeeded in expanding beyond his 12 in-house physicians to bring in additional business from the outside. The team at Saint Joseph Mercy Health System did extensive outreach to local media, issuing press releases to make outlets aware of the new offerings. “We also did billboards, and those spoke to the claustrophobic patients, because we really wanted to grab their attention and let them know that we have this new opportunity,” Knauf says. “We also did some mall poster advertisements and brochures, but no radio yet. We did fliers for the physician community to inform them of this new technology, and we do get calls from physician offices requesting information.” Prior to getting the open system at Saint Joseph Mercy Health System, nearby physicians would occasionally have to send patients 60 miles away because there was no open system nearby. Once the physicians realize that the final image is comparable to that from conventional systems, Knauf says, the rest is easy. “Open systems have been out there for a long time, and a lot of physicians believe that the image quality is not as good on a traditional system,” Knauf says, “but this is brand-new technology, and it is a high-field open magnet, and that quality question goes away. People still largely have not caught on to the new technology. Last year, we were only the third installation in the country of this system, so it is very new.” Knauf expects to see a return on investment (ROI) in about three years, which he views as fairly typical for a large purchase of this nature. Saint Joseph Mercy Health System already has three magnets on its Ann Arbor campus, so the open unit is designed to add capacity. Schedulers never book the open magnet completely so that slots will be open for the convenience of patients who can’t tolerate the closed systems. Knauf admits that this scheduling decision will be likely to delay ROI, but he says it is worth it because patients will ultimately benefit from the availability of high-field open MRI