MRI’s Pepsi Challenge: Comparing Boreless and Wide-bore Technologies
Harley HammermanLingering doubts about the image quality generated by open-bore MRI technology have, perhaps, unfairly held up its adoption. When a pair of radiology organizations set up the equivalent of an MRI Pepsi® challenge in their respective practice environments, staff members at both locations were surprised at the response. Mike ScheideckerWhen Huntsville Memorial Hospital (HMH) in Texas was in the process of deciding on a new MRI system, the facility had narrowed its choices down to the Oasis boreless system from Hitachi Medical Systems and two wide-bore systems from competing vendors. Mike Scheidecker, RT(R), MRI/CT director at HMH’s outpatient imaging center, recalls that HMH flew its radiology director, Jason Loftin, to vendor sites from all three companies, and he was scanned (using the same sequences) at each site. Image Quality Side by Side When the resulting studies were circulated (with no indication of their sources) among HMH radiologists, 80% chose the scans from the Oasis as being the best. Scheidecker gives the system’s fat-suppression capabilities credit for the superior images that it produces. He praises the lateral movement of the Oasis table, as well as its 32-inch width, as features that allow for greater ease in imaging joints that might otherwise require uncomfortable manipulation. “Everything you scan is in the middle, so you get perfect images every time,” he says. “It is the perfect extremity scanner for doing shoulders. My cylindrical bore is a big mess; I have to contort you in some awkward position to do wrist MRI. It’s uncomfortable, and it’s a 45-minute scan. In the Oasis, you just lie down, with your arms at your sides, and listen to the stereo system.” Scheidecker adds that the system’s ability to image obese patients makes it a particularly good choice for the community’s bariatric population. “I had one day where all 10 of my patients were over 400 pounds,” he says. “Even when you’re five feet two inches tall and you weigh 250 pounds (as my average patient seems to), you can lie down and be scanned.” The effectiveness of an imaging system is influenced by another factor as well: patient comfort. In a side-by-side comparison, a different organization discovered that it could improve its patient tolerance—and its image quality—by using a boreless MRI system. Patient Comfort Side by Side Harley Hammerman, MD, CEO of Metro Imaging (Creve Coeur, Missouri), says that, for a time, one of his practice’s locations had boreless and short-bore systems in the same facility. This change in practice patterns was revealing to Hammerman and his team. “We moved the short-bore system from one office,” he recalls. “When it moved to the other office, where patients had been accustomed to the open magnet, they didn’t have the same experience.” In short, Hammerman says, Metro Imaging experienced more tolerance problems with the short-bore system once patients were able to see the boreless Hitachi system as an alternative available in the same office. He adds that the combination of patient-friendly technology and great service from technologists adds up to better patient comfort and, ultimately, better images. “We try to have technologists here who could work at Disney,” he says. “If the technologist spends the time with the patient, and the patient’s comfortable with the magnet, you get good images.” Scheidecker and his team experienced similar results, in terms of patient accommodation, on the Oasis system. “We’re able to scan children with their parents on the table, which is also unique, owing to the open architecture,” Scheidecker says. “Oasis has a motion-correction technology, and the combination allows us to scan the kids without the need for them to undergo general anesthesia.” Having a parent-assisted exam in the boreless MRI at HMH saves families an 80-mile drive to see a pediatric anesthesiologist at Texas Children’s Hospital in Houston, where they might even be forced to pay out-of-network prices, Scheidecker notes. “We offer the service to our pediatricians, and we say that if the kid can’t tolerate it, there’s no charge for the study,” he says. A Disappearing Stigma Given a money-back guarantee and double-blinded endorsements, is the bias against open MRI systems still alive and well? Scheidecker says that it is, to a certain degree, but that it is rapidly eroding, thanks to the image quality offered by systems such as the high-field, boreless Oasis system. “There is some issue convincing everybody out there that this system is as great as it is,” Scheidecker says. “In the past, having open MRI was like using a four-letter word. Part of what we’ve done is bring in the neurosurgery groups and tell the physicians to lie on the table. We get patients from 100 miles away.” Hammerman agrees that the playing field is leveling, as facilities that didn’t formerly have the technology—and that disparaged it publicly—are reversing course in their marketing campaigns. “It's not like we're the only game in town anymore. The early magnets got a bad rap, and that’s sort of stuck around,” he says. “It’s all from physicians, and to be honest, some of it is political; now, hospitals are buying up physicians, and physicians are investing in imaging. St Louis is the poster child for that. It’s not like we’re the only game in town anymore.” Scheidecker says that HMH partner radiologists now refer patients to the Oasis system from their own practices in College Station because they prefer the quality of the scan. “They’re actually taking money out of their own pockets to scan patients, when it’s appropriate,” he says. “When physicians are willing to part with money, you know you have something worthwhile.” Matt Skoufalos is a staff writer for