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Memorial Hospital, Belleville finds Philips 3.0T system a perfect fit

Best Practice
Dr. Harris, Alan, M.D. Belleville, Memorial Hospital USA
Murphy, Patrick Belleville, Memorial Hospital USA

State-of-the-art 3.0T MR systems are becoming ubiquitous in all clinical scanning environments, despite early predictions that 3.0T would operate predominantly in urban academic medical centers. Increasingly, medical officials at small and medium-sized, community-based hospitals are acquiring 3.0T systems in recognition of these systems' advanced clinical capabilities, immediate clinical practicality and competitive value. Clinicians at Memorial Hospital, a 313-bed community medical center in Belleville in southwest Illinois, have found that their Philips 3.0T fulfills all three of these criteria.
 Alan Harris, M.D. Patrick Murphy, R.T. Memorial Hospital, Belleville, Illinois
Alan Harris, M.D.
Patrick Murphy, R.T.
Memorial Hospital, Belleville, Illinois

Philips 3.0T systems in demand for all clinical environments

With a Philips Intera 1.5T already in operation at Memorial Hospital, choosing a vendor to supply a second system in 2004 wasn't a major issue, according to Memorial's chief MRI technologist Patrick Murphy. "We've been impressed with the 1.5T system's image quality and with Philips' service and applications, so although we were evaluating another company's MRI products as well, Philips had an advantage," he says. "Conversely, selecting the field strength was a very big decision for us, since we are in competition with area hospitals as well as St. Louis hospitals and many stand-alone centers in the area. We thought that while we might be on the MRI forefront today, a year from now we might not be. We wanted to buy a system that would differentiate us competitively right away."


"We have always tried to be cutting edge with our radiology equipment," agrees Memorial radiologist Allan Harris, M.D. "Marketing is part of that, but improved diagnostic accuracy is the ultimate goal." The Philips 3.0T system also is very compact and lightweight yet has an extremely spacious patient opening compared to other 3.0T systems on the market, Murphy adds.


He also remarks that Philips' SAR management enables Memorial Hospital to exploit the full potential of the 3.0T field strength safely. Memorial Hospital's Philips 3.0T system became operational in November 2004. During the 3.0T's first full year of use, the number of scans went up 17 percent, Murphy notes. The system scans about 30 patients per day, Monday through Friday, from 6:00 a.m. to 8:30 p.m., and is open from 8:00 a.m. to noon on Saturday.


55-year-old female with metastatic disease after breast cancer presents with memory loss and visual disturbance. Patient underwent chemotherapy, radiation therapy and Gamma KnifeĀ® surgery.White matter signal hyperintensity is seen bilaterally in the supratentorial compartment, consistent with the history of radiation therapy.The second image shows a large lesion.

Better imaging in all areas

With its 3.0T system, Memorial Hospital is equipped for the future, but clinicians enjoyed immediate benefits, Murphy says.


"We're seeing parts of anatomy that once were only hand-drawn diagrams in a book to us - such as the anatomy of the inner ear," he says. Neuro MRI studies (spine and brain) represent 30% of Memorial Hospital's volume.


The extra signal at 3.0T enables easy implementation of scans employing smaller slice thicknesses or 3D imaging for small IAC structures, Dr. Harris adds. "We perform a 3D, fat-suppressed TSE sequence in the IAC and visualization of the cranial nerves and vestibular-cochlear anatomy is excellent. We can see erosion into the semi-circular canals by a mass or other aggressive infection. In terms of overall brain anatomy, at 3.0T I can see the sulci and gyri better and the grey-white differentiation is sharper. It's all related to improved SNR - that's the currency in MRI."


In brain MRA studies, the higher SNR at 3.0T also helps resolve ever smaller branches of the cerebrovasculature, he says. Regarding MRA in general, Dr. Harris adds, "estimation of stenosis is closer to what is found during surgery."


39-year-old female presented with peripatellar pain and swelling due to sports injury. The T2-weighted coronal image demonstrates a horizontal cleavage tear involving the posterior horn and body of the lateral meniscus. 36-year-old female presented with wrist pain and swelling following a motor vehicle accident. Coronal PD-weighted SPIR demonstrates a nondisplaced fracture through the radial styloid with surrounding edema.

For musculoskeletal studies (35%), Memorial Hospital's 3.0T system and dedicated orthopedic imaging coils are increasingly building a reputation among referring physicians, according to Murphy. "A physician from Chicago, which is about 300 miles away, even sent us a patient for a 3.0T wrist MRI," he says.


"The difference in cartilage visualization and overall spatial resolution in musculoskeletal studies between 1.5T and 3.0T is dramatic," Dr. Harris says. "With the 3.0T system, it's much easier to identify subtle cartilage irregularities, such as fissures and areas of partial focal cartilage loss. The tendons also appear much sharper at 3.0T than at 1.5T."


MRCP, as a procedure, has seen a 25 percent jump in numbers due to improved depiction of ducts and reduced scan time at 3.0T, Murphy notes. "At 3.0T, we can use less IV contrast, which is a savings for the hospital and the scan times are not as long," he says.


"The 3.0T field strength gives us the opportunity to either decrease examination time or increase spatial resolution. For most applications we choose a mixture of both," Dr. Harris explains. "In the abdomen, our MRCPs and MR urograms come out with high SNR and sharp margins, a significant difference from imaging done at 1.5T."


For all applications, Memorial Hospital clinicians were also able to exploit the SENSE technique, to enable dramatic accelerations in acquisition speed and increases in spatial resolution, he adds.


60-year-old male presented with acute low back and bilateral leg pain. The T2-weighted sagittal image demonstrates a severe central canal stenosis at L2-L3 due to a large extruded disk. The traversing nerves are compressed at L2-L3 level. Moderate to severe degenerative changes of the facets at L4-L5. A 16 mm hemangioma in L4. 48-year-old female presented with right upper quadrant pain with elevated liver function lab values. MRCP demonstrated a mild prominence of the biliary tree compatible with known cholecystectomy.

Breast imaging center of excellence

With St. Louis, Missouri less than 20 minutes away by car, Memorial Hospital officials had assumed in 2004 that intense competition for sophisticated breast MRI services would obviate such a program at Memorial, regardless of their MR system's field strength. "We were surprised to find that there are only two hospitals in the entire St. Louis area that provide breast MRI," Murphy says. "No one could give us a reason not to pursue a breast MRI service so we jumped into it."


Just five months old at press time, Memorial Hospital's breast MRI program features the Philips 3.0T system, dedicated breast RF coil and digital imaging workstation with an extensive set of computer-aided detection (CAD) tools for real-time image analysis. Approximately 15 patients have been scanned by mid- May, 2006.


"Mammography and MRI are complementary modalities," Dr. Harris asserts. "Indications for breast MRI include assisting in the determination of cancer spread and detection of contralateral disease. This facilitates preoperative planning that aims to identify candidates for either breast conservation therapy or mastectomy. In patients with mammographic or sonographic evidence of an enlarged lymph node, but with no accompanying evidence of malignancy, MRI can help us identify the lesion.


"MRI also is useful for monitoring progression of therapy, such as neoadjuvant chemotherapy, and whether there is recurrent tumor following therapy," he continues. "Finally, breast MRI is used to evaluate questionable or inconclusive findings on mammography or breast ultrasound."


Memorial Hospital had been preparing to launch its breast MRI service with its Intera 1.5T as the centerpiece. However, when acquisition of the 3.0T system became imminent, officials delayed the program to coincide with delivery of the higher field strength system.


"The MRI imaging of possible breast disease, particularly breast cancer, is based predominantly on lesion morphology - its margins, internal architecture such as septations and external characteristics such as spiculation," Dr. Harris observes. "Because of 3.0T's improved spatial resolution we are able to more accurately characterize lesion morphology, which should lead to improved diagnosis. The higher field strength also helps us identify the lesion's vascular supply and enhancement characteristics so that we're better able to create vascular maps of the lesion's blood supply. This helps surgeons perform their preoperative planning." Murphy adds that the expertise to conduct breast MRI at 3.0T was "borrowed" initially from another Philips customer. Memorial Hospital appropriated a breast imaging protocol contributed to Philips' NetForum Community and also takes advantage of opportunities to download ExamCards. "It was important to investigate what others were doing - utilizing NetForum and ExamCards in addition to the Philips users meeting," he says.

Ready for "prime time"

Regardless of the scanning environment, some have questioned whether 3.0T is ready for routine clinical use, popularly expressed as "prime time." Centers like Memorial Hospital are proving every day that 3.0T is equipped for all imaging settings, Dr. Harris says.


"Not only is 3.0T ready for prime time, but we've shown that it can handle at least a moderately high patient load with fewer recalls and can scan faster while also providing improved image quality," he says. "So, is 3.0T ready for prime time? The answer is a resounding yes."


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Nov 10, 2006

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Best Practice
Intera 3.0T
Release 10, Release 11, Release 9
Master / Quasar Dual
Body, Brain, Breast, IAC, Knee, Musculoskeletal, Neuro, Total spine, Vascular, Wrist

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