Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | Magnetic Resonance Imaging (MRI)| March 02, 2016

MR is About to Get Faster, Cheaper and More Valuable: It's About Time

MR is About to Get Faster, Cheaper and More Valuable: It's About Time

Advances promise to make MR heart scans routine. (Graphic courtesy GE Healthcare)

It’s been almost 40 years since the first human magnetic resonance (MR) pictures were taken. Along with decades of experience we’ve seen the development of custom sequencing and mind-boggling advances in computer processing. Yet there has been virtually no change in the length of exams.

I was at a loss to explain it to my son a couple weeks ago, when he asked me why it took an hour to scan his shoulders. Before putting in the earplugs to guard against the other worldly noises of MR, he was coached by the technologist to stay as still as he could. Movement, he was told, might result in the need for a retake.

He spent an hour in that cylinder, about the same exam time for patients in the 1980s. I received a second dose of déjà vu when the summary of charges arrived. When my wife me asked me to guess, being something of a cynic, I price it at what I thought was the high-end — $2,500 maybe. I was 300% too low.

There is an old saying that work expands to fill the time available for its doing. Another dictates that prices will rise to whatever the market will bear. If these are the reasons why my son’s MR exam took an hour and were charged north of $7,000, MR providers are going to be in for a big surprise.

The idea of allocating one-hour slots for individual patients is nearing the end of its lifetime. If historic trends continue, MR procedure volume will increase not only for traditional central nervous system (CNS) applications but on the heels of advancing clinical capabilities. Breath-hold scanning without respiratory gating has flung wide the door to routine abdominal imaging, including the liver — a possibility now being explored as part of a multi-site clinical study sponsored by the National Institutes of Health (NIH). A new MR algorithm produces images that rival those of CT (See “RSNA Technology Report 2015: MRI”; 1:20 in the video). And cloud supercomputing of cardiac scan data has raised the possibility that MR heart imaging could be an everyday occurrence (See “RSNA Technology Report 2015: MRI”; 3:30 in the video).

Then there is the financial argument. My son was scanned at 6 pm on a Friday night. The cost of running an MR operation for 12 hours is on a collision course with the tenets of value medicine. Charges of more than $7,000 for a single scan will be intolerable in the near future. (Truth be told, arrangements between the hospital and my insurer shifted over $4,000 in charges back to the provider. Remaining, however, was a $2,600 charge of which our insurer paid the vast majority.)

The time is coming when providers will tire of discounting services more than 60 percent; insurers will balk at picking up even heavily discounted bills; and radiology administrators will refuse to extend schedules and pay overtime for technologists. When they do, MR providers will have to be ready. The good news is that they probably will be.

 

We are rapidly approaching a time when the underlying processes that run medical imaging scanners will be all but fully automated. Already the medical community has taken strides toward image-enabling the enterprise. This will pave the way to the integration of electronic medical records (EMR) and the workflow engines that drive radiology departments. Exam orders from referring physicians will pass directly to scanners, triggering set protocols in the context of anatomical data and patient history from the EMR. This will establish the basis for decisions, made by MR scanners machine — and instituted under human guidance — as prescribed by best practices that dictate specific MR sequences for handling certain disease and patient types.

The boost in efficiency will be unprecedented.

Exam times will shrink, as set up and scanning are streamlined, and the use of smart algorithms (see “Smart Scanners: Will AI Take the Controls?”) to optimize sequences and the resultant acquisition of data further streamline the process.

Technologists will do what people do best — interact with patients to make their experience as comfortable as possible. No longer will they be placed in the role of warning patients that their movement could result in going through the agonizing process of an MR scan a second time.

If we truly are committed to pursuing patient-centric healthcare, minimizing discomfort by getting the patient out of the MR scanner as quickly as possible has to be a priority. It is unfortunate that it will have taken the prospect of diminishing resources to achieve what should have been a major goal from the very beginning.

Editor’s note: This is the first blog in a series of four by industry consultant Greg Freiherr on MR Balances Speed and Clinical Reach. To read all of Greg's blogs, click here.

Related Content

An example of Philips' TrueVue technology, which offers photo-realistic rendering and the ability to change the location of the lighting source on 3-D ultrasound images. In this example of two Amplazer transcatheter septal occluder devices in the heart, the operator demonstrating the product was able to push the lighting source behind the devices into the other chamber of the heart. This illuminated a hole that was still present that the occluders did not seal.

An example of Philips' TrueVue technology, which offers photo-realistic rendering and the ability to change the location of the lighting source on 3-D ultrasound images. In this example of two Amplazer transcatheter septal occluder devices in the heart, the operator demonstrating the product was able to push the lighting source behind the devices into the other chamber of the heart. This illuminated a hole that was still present that the occluders did not seal. 

Feature | Ultrasound Imaging | February 07, 2019 | Dave Fornell, Editor
Here is a list of six key trends in ul...
Podcast | Cybersecurity | February 04, 2019
Cyber hackers pose a worsening threat to radiology and the rest of medical imaging.
The top article from January was about researchers in Sweden using computed tomography (CT) to image the soft tissue of an ancient Egyptian mummy’s hand down to a microscopic level. Non-destructive imaging of human and animal mummies with X-rays and CT has been a boon to the fields of archaeology and paleopathology. Most popular radiology articles and news in January 2019.

The top article from January was about researchers in Sweden using computed tomography (CT) to image the soft tissue of an ancient Egyptian mummy’s hand down to a microscopic level. Non-destructive imaging of human and animal mummies with X-rays and CT has been a boon to the fields of archaeology and paleopathology.

Feature | February 01, 2019 | A.J. Connell and Dave Fornell
February 1, 2019 — Here is the list of the most popular content on the Imaging Technology News (ITN) magazine website
In today’s digital environment, a radiologist only sees images saved and shared to the PACS, so a firm understanding of X-ray reject rates is crucial for high image quality and good workflow.

In today’s digital environment, a radiologist only sees images saved and shared to the PACS, so a firm understanding of X-ray reject rates is crucial for high image quality and good workflow.

Feature | Digital Radiography (DR) | January 29, 2019 | By Jeff Zagoudis
X-rays were the first medical imaging technology to be invented, and they remain one of the most commonly performed e
Artificial intelligence, also called deep learning and machine learning, was the hottest topic at the 2018 Radiological Society of North America (RSNA)) meeting.

Artificial intelligence was the hottest topic at the 2018 Radiological Society of North America (RSNA)) meeting, which included a large area with its own presentation therater set asside for AI vendors.

Feature | Artificial Intelligence | January 10, 2019 | Dave Fornell, Editor
Hands down, the hottest topic in radiology the past two years has been the implementation of...
Researchers Awarded 2018 Canon Medical Systems USA/RSNA Research Grants
News | Radiology Imaging | November 13, 2018
The Radiological Society of North America (RSNA) Research & Education (R&E) Foundation recently announced the...
Charles Ananian, M.D.

Charles Ananian, M.D.

Sponsored Content | Case Study | Digital Radiography (DR) | November 07, 2018
Whether it’s a premature baby or a critically ill child, treating little patients is a huge responsibility.
Results of the vertebrae-based analysis (383 vertebrae in 34 patients) for detection of BME.

Results of the vertebrae-based analysis (383 vertebrae in 34 patients) for detection of BME.

Sponsored Content | Case Study | Computed Tomography (CT) | November 06, 2018
The following is a summary of a study published in the
An example of the newest generation of smart cardiac CT software that automatically identifies the anatomy, autotraces the centerlines on the entire coronary tree and labels each vessel segment.

An example of the newest generation of smart cardiac CT software that automatically identifies the anatomy, autotraces the centerlines on the entire coronary tree and labels each vessel segment. This greatly speeds CT workflows, saving time for techs, radiologists and cardiologists.

Feature | Radiology Imaging | October 04, 2018 | By Dave Fornell
Here is a checklist of dose-sparing practices for cardiac computed tomography (CT) imaging used in the cath lab.
Philips Launches Ingenia Ambition X 1.5T MR
News | Magnetic Resonance Imaging (MRI) | September 14, 2018
September 14, 2018 — Philips announced the launch of the Ingenia Ambition X 1.5T...