In MR imaging, a faster exam typically leads to fewer motion artifacts and greatly enhances the patient experience. However, fast does not always translate to better image quality. By upgrading their scanner to a SIGNA™ Premier with AIR™, imaging providers such as Precision Imaging Centers can have both speed and image quality.
With four imaging centers in the Jacksonville area, Precision Imaging Centers is committed to "bringing excellence to imaging." With a new SIGNA™ Premier Lift and AIR™ Coils at its primary Jacksonville, Florida facility, the organization is doing just that.
"We had a GE SIGNA™ Excite 3.0T for 12 years, but wanted a scanner that could produce higher quality images and also reduce our scan times," says Joe Seibert, RT(R)(MR). "We could have replaced our existing system, however, it would not have been as great as we have now."
SIGNA™ Premier has a 70 cm bore that can more comfortably accommodate larger-sized patients compared to the 60 cm bore on SIGNA™ Excite. It also is packed with the latest advancements in sequences, enabling Precision Imaging Centers to improve upon the type of MR studies, including brain perfusion and higher-quality DTIs, and expand further into specialized exams such as susceptibility weighted imaging of the brain using SWAN.
While the larger bore size was a key consideration, acquiring AIR™ Coils was just as important. As a result of the new system and coils, Precision Imaging Centers completes most exams in 15-minute slots and has increased the number of patients scanned each day from an average of 35-38 patients to 45-50 patients in a 16-hour day.
Versatility and adaptability
With a larger-sized and older patient population, positioning can be a challenge for even the best technologist. Some patients may not fit in the hard shell, rigid coils while others could not lie still in the position needed to obtain a quality MR exam, such as the "superman" position with the arms above the head. Now, with the AIR™ Anterior Array (AA) Coil, the AIR™ Multi-Purpose (MP) Coils‡ and the Posterior Array (PA) Coil embedded in the table, Seibert has total positioning freedom with coils that not only behave like a blanket but feel like one for his patients.
"The smaller AIR™ MP Coils are easier to position closer to iso-center, even when the arms are down by the patient’s side," Seibert explains. "We can also use higher acceleration factors with AIR™ than with the rigid coils – we are consistently using a factor of 2 versus 1.5 with the hard coils."
AIR™ is also a significant time saver for the technologists. Seibert and his staff of technologists are not swapping out coils as often, or moving patients on and off the table to change coils. Plus, one AIR™ AA Coil can be used for multiple body areas without moving it. With a single touch, AIR Touch™ automatically selects the best coil element combinations for each patient over the precise region of interest.
Figure 1.
Prostate exam with MAGiC DWI has helped shorten total exam times from 40 min. down to 20 min. (A) Axial T2, 0.6 x 0.9 x 3 mm, 4:15 min.; (B) axial FOCUS DWI b800, 1.8 x 1.2 x 3 mm, 5:56 min.; (C) axial FOCUS MAGiC DWI b1400; (D) axial FOCUS MAGiC DWI b2000; and (E) axial FOCUS DWI ADC map.
"Not changing coils is a huge benefit for us and our patients, especially our multiple sclerosis patients," says Seibert.
He explains that previously, a multiple sclerosis (MS) patient undergoing a combined brain-cervical and thoracic spine with contrast MR exam would be taken off the table at least two times to change coils and add foam padding. Now, they use the AIR™ AA Coil for the cervical and thoracic spine acquisitions.
We put the AIR™ Coil on and don’t have to go back into the room, and that has saved us 45 minutes to one hour for these exams."Joe Seibert
The same is true for a lumbar exam; the technologist can place the AIR™ AA Coil and image both a lumbar and a pelvis without changing coils.
It's MAGiC DWI
Prostate imaging is another exam where the AIR™ MP Coil and SIGNA™ Premier with synthetic diffusion (MAGiC DWI) are shortening exam slots and improving image quality. The center performs 22-24 prostate exams a day when fully booked; in one eight-hour shift, Seibert will have 5-6 multiparametric and 3-4 surgical planning prostate exams. The use of MAGiC DWI to capture higher synthetic b-values and the higher acceleration factors with the AIR™ MP Coil have cut time slots in half, from 40 to 20 minutes. In fact, prostate studies are the only exams that are booked for 20 minutes; all others are 15 minutes.
"Prostate exams used to be more difficult with the fixed array coil, sometimes creating positioning issues," Seibert explains. "Also, trying to get the right b-values without the patient moving was tough. Having the AIR™ Coil right up against them and using PROPELLER keeps the time down and the imaging quality much nicer than before.
"MAGiC DWI is a huge game changer. Our prostate oncologist referrers absolutely love MAGiC DWI because of the high synthetic b-values," Siebert adds. "We couldn’t reach those before and the image quality is coming out great."
Adam Brochert, MD, MBA, a radiologist who reads most of the prostate exams from Precision Imaging Centers, has also seen the impact of the new scanner, coils and sequences.
"The faster scan times lead to greater patient comfort and that translates to decreased motion artifacts," Dr. Brochert explains. "Lesion conspicuity is noticeably increased and has significantly increased my diagnostic confidence. This is particularly apparent in follow-up prostate MR exams on patients who had prior studies on the older system."
The new MAGiC DWI post-processing tool delivers a considerable difference with high image quality when it comes to diffusion."Dr. Adam Brochert
Dr. Brochert has also received comments from referrers who appreciate the improvement in accuracy and radiologist reporting confidence.
"Advanced body imaging, such as the prostate and abdomen, are now clearly better. Routine imaging of the spine and joints also can be acquired faster, along with the improved quality of the images," Dr. Brochert adds. He also suggests that a provider interested in better image quality and/or increased patient throughput should take a close look at SIGNA™ Premier and AIR™.
Seven-minute brain MR
Precision Imaging Centers performs a lot of routine brain MR exams. Now, with SIGNA™ Premier, a routine brain exam consisting of a T1 MP-RAGE with very thin slices, axial T2, diffusion, FLAIR and a post-contrast T1 MP-RAGE are down to 7 minutes.
"With the SIGNA™ Premier we can use higher acceleration factors to acquire an axial T2 in around 30 seconds, an axial FLAIR sequence in around 1 minute, 20 seconds and the MP-RAGE in around 2 minutes, 20 seconds," says Seibert.
Figure 2.
Precision Imaging Centers is now performing routine brain exams in 7 minutes with SIGNA™ Premier. Total scan time in this case was 6:59 min. (A) Axial T1 MP-RAGE, 1.0 x 1.0 x 1.8 mm, 2:23 min.; (B) axial DWI b1000, 1.9 x 1.9 x 5 mm, 0:21 min.; (C) axial T2 FLAIR, 0.8 x 1.1 x 5 mm, 1:21 min.; (D) axial T2, 0.7 x 1.0 x 5 mm, 0:31 min.; and (E) axial T1 MP-RAGE post contrast, 1.0 x 1.0 x 1.8 mm, 2:23 min.
On the older system, Seibert and his colleagues would sometimes dread having to do a brain and IAC exam. It almost always ran over the allotted 15 to 20-minute time slot because of the small slice imaging of the inner ear. Using volume imaging with auto reformats, these exams take approximately 11 minutes to acquire a T1 Cube, T2 Cube, diffusion, FLAIR and post-contrast T1 Cube.
"Volume imaging is great in neuro exams, especially on our MS patients we can acquire one volume on the FLAIR. If someone moves, we just repeat the 1-minute sequence," Seibert adds.
When our patients find that we can provide them with better imaging in half the time than they are used to, that is something they really like."Joe Seibert
No compromise in orthopedics
Precision Imaging Centers has a lot of orthopedic referrers. The ability to wrap the AIR™ MP Coil around an extremity or joint has its advantages. For example, when imaging the entire lower leg, the technologist will move the other leg out of the FOV to achieve more iso-center imaging in the 70 cm bore without compromising quality for speed.
Figure 3.
AIR™ MP Coils provide the flexibility needed to image joints and extremities. For larger FOVs, Precision Imaging Centers can use the AIR™ AA Coil. Toe exam using the 21ch AIR™ MP Coil (Large), (A) sagittal T1, 0.4 x 0.5 x 2 mm, 0:39 min. and (B) sagittal T2 FatSat, 0.4 x 0.5 x 2 mm, 1:23 min.; (C) hip arthrogram, coronal T2 FatSat, 0.7 x 1.1 x 4 mm, 2:03 min., 30ch AIR™ AA Coil; and (D) elbow arthrogram, axial T1 FatSat, 0.4 x 0.7 x 3 mm, 1:52 min., 21ch AIR™ MP Coil (Large).
AIR™ MP Coils are used for most extremity MR exams, including 100 percent of hands, elbows, forearms, humerus, hips, thighs and lower legs. Approximately 50 percent of shoulder, knee, foot and ankle scans are also conducted with AIR™ MP Coils. Although Seibert says he gets a better signal and can use faster acceleration with AIR™ MP Coils for foot and ankle exams, the rigid coils may provide better stabilization in some patients and is therefore still utilized. For long bone and sports hernia exams, the center did not have the proper coils before, so AIR™ MP Coils have enabled them to provide these as well. In the thigh and long bone studies, the orthopedic surgeons are happy with the lack of rounded edges or fat saturation in the image.
Since installing the new system and acquiring the AIR™ Coils in August 2019, Precision Imaging Centers has improved workflow and productivity while simultaneously enhancing clinical performance. It’s not just a winning solution for the center, but also for its patients and referring physicians.
