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MidMichigan thriving with Panorama HFO and Achieva 3.0T X-series

Best Practice
Mr. Ferrier, Jim Midland, MidMichigan Regional Imaging USA
Vanderpol, Michael, R.T. Midland, MidMichigan Regional Imaging USA
Wolschlager, Chris, R.T. Midland, MidMichigan Regional Imaging USA

The expansion, replacement or refitting of its MRI system array in 2006 was MidMichigan Regional Imaging's (Midland, Mich. USA's) opportunity to set the imaging service apart from its competition and enable it to diversify its patient demographics. MidMichigan decided to take advantage of what Philips calls a "4 Tesla" configuration, a Panorama High Field Open (HFO, 1.0T) system plus an Achieva 3.0T X-series scanner, enabling both patient-friendly, open high field scanning and the SNR to perform high resolution and advanced applications. The 4 Tesla solution (plus a mobile 1.5T system) is helping MidMichigan shoulder a busy seven-day, 105-hour scanning week.
 Panorama HFO at MidMichigan. The MR team in front of the Achieva 3.0T X-series.
Panorama HFO at MidMichigan.
The MR team in front of the Achieva 3.0T X-series.

"4 Tesla," two-system solution spans widest spectrum of studies

Michigan is a certificate-of-need (CON) state; capital equipment acquisitions are carefully controlled, mainly to hold down healthcare costs. Essentially, imaging centers are required to obtain CON approval from state government to acquire higher-priced capital equipment, and this is based on the available patient volume for each system. In the case of MRI systems, CON regulations compel centers to maximize the versatility and efficiency of their scanners.


"In 2005, our competitive environment for MRI suggested that having both 3.0T and high field open systems would differentiate us from other MRI providers," says Jim Ferrier, president of MidMichigan Regional Imaging, an independent diagnostic testing facility. "No other MRI configuration would provide that kind of coverage for patients and study types, thereby keeping both systems optimally productive in this CON environment.


"The Panorama HFO would provide a solution for scanning patients that were claustrophobic or too large for our 1.5T scanner," he continues. "And we opted for the 3.0T to not only maintain our existing patient base, but also to gain from the potential to perform advanced applications when we begin to implement them here."

Building MidMichigan's reputation

MidMichigan Regional Imaging - established January 1, 2003 with a Gyroscan NT 1.5T mobile system - is a specialty service affiliate of MidMichigan Health, a large family of healthcare organizations. MidMichigan Regional Imaging's mobile 1.5T serviced the MidMichigan Regional Medical Center-Midland. The service added a second system, an Intera 1.5T, in December 2003 and installed it at the Midland hospital. The mobile system then began serving the Clare and Gladwin medical centers.
 Jim Ferrier Chris Wolschlager Mike Vanderpol
Jim Ferrier
Chris Wolschlager
Mike Vanderpol

Panorama HFO up first and making an impact

In November 2006, MidMichigan's Panorama HFO became operational at MidMichigan Medical Center-Midland. "We had seen how we could get 1.5T-quality images on the open Panorama system," says Mike VanderPol. Vanderpol and Chris Wolschlager serve as MidMichigan's imaging supervisors. "That was key. We didn't want to replace the workhorse 1.5T system if the Panorama HFO wasn't capable of producing similar or better images."


The system's openness promised to eliminate claustrophobic rejection and reduce the need for pediatric and adult sedation, Wolschlager adds. "We have noticed a decrease in sedation to decrease anxiety," he says. "We also can scan a greater range of patient sizes. In fact, during our first two days of operation, we scanned a 360-pound patient we could not have scanned before. "


"For obese patients, the Panorama HFO has a high performance Integrated Body coil," VanderPol notes. "Therefore, positioning an RF coil is unnecessary to obtain a good lumbar image. And, for off-center anatomy, such as wrists and shoulders, there is a clear advantage in being able to position the patient in the isocenter."


"The referring neurosurgeons and neurologists are happy having their patients scanned on Panorama HFO," says MidMichigan neuroradiologist Michael Bartlett, M.D. "I have seen patients who have had satisfactory cervical spine studies on a 1.5T system, have subsequent scans on the 1.0T that were actually much better. And, in terms of MS lesion visualization, there is no drop-off in image quality going from 1.5T to HFO."


By March 2007, Panorama HFO had scanned 1,800 patients, averaging 15 patients per day over a seven-day week. This system's case volume comprises 60% neuro and 40% musculoskeletal studies.



Brain on Panorama HFO. 67-year-old female patient with extensive involvement of cerebral white matter with demyelinating plaque formation, multiple sclerosis with progressive involvement particularly of the brain stem. Scanned on Panorama HFO with ST SENSE Head coil.



Wrist on Panorama HFO. Right wrist of a 47-year-old

male patient scanned on Panorama HFO with ST SENSE

Wrist coil. This patient has a history of ganglion cyst

with prior resection. This image shows no evidence of

recurrent ganglion cyst.


Achieva 3.0T increases center's scope

Although Ferrier was concerned that some patients would have contraindications against 3.0T scanning, such as surgical implants and aneurysm clips, a visit to Nevada Imaging Centers (Las Vegas, Nev.) - a Philips show site - dispelled his concerns.


"We were impressed with the breadth of patients scanned on Achieva 3.0T," he says. "We believed 95-98% of our patients could be scanned on this system."


Adhering to CON requirements, MidMichigan's second system - the fixed Intera 1.5T - was decommissioned on February 4, 2007 to allow the Achieva 3.0T X-series to begin operation in February. MidMichigan then shipped out the Intera for refitting as a mobile system. It replaced the mature mobile Gyroscan NT 1.5T system in April 2007.


The Achieva 3.0T has excelled at a variety of applications that demand high resolution, such as IAC and smaller MS plaques. "We prefer doing IACs on the 3.0T unless the patient is claustrophobic," Dr. Bartlett says. "Two referring neurologists have asked that MS follow-ups be done on the 3.0T, because we're visualizing small plaques better than at 1.5T. In the 3D IAC studies, we routinely see the 9th, 10th, and 11th and sometimes
6th cranial nerves."


Enhanced definition of the circle-of-Willis is very noticeable on MRAs, he adds. "You see the smaller, more peripheral branches of the cerebral arteries dramatically better on 3.0T than at 1.5T," Dr. Bartlett says. "I'm also more confident in identifying small aneurysms and in cerebrovasculature evaluation after stroke."


Achieva 3.0T X-series provides exceptional knee imaging, Wolschlager adds. "The Panorama HFO and the 1.5T do a very good job on knees," he says. "But with Achieva 3.0T, combined with the SENSE Knee coil, these studies, especially for cartilage imaging, have been just marvelous - they're beautiful."


PD SPAIR T1 post contrast
T1 post contrast

Knee on Achieva 3.0T X-series. The sagittal left knee image of a 57-year-old female patient shows a small ganglion cyst posterior to the posterior cruciate ligament with Baker's cyst. The post-contrast image shows a small tear of the posterior horn of the medical meniscus. Scanned on Achieva 3.0T with SENSE Knee coil.


3D T2 DRIVE T1 post contrast
T1 post contrast

IAC on Achieva 3.0T X-series. 41-year-old male patient with left-sided acoustic schwannoma. Scanned on Achieva 3.0T with SENSE Head coil.


Diffusion tensor imaging (DTI), cardiac MR to debut

MidMichigan clinicians will soon harness Achieva 3.0T for white matter fiber tracking, Dr. Bartlett says. The technique has been useful in presurgically determining the relationship of fiber tracts to brain tumors and in localizing fiber tracts in relationship to MS plaques.


In addition, in April 2007, MidMichigan staff are going to begin training on certain cardiac applications, including ventricular function imaging, VanderPol says.

4 Tesla combination adds up to wider patient variety and new applications

MidMichigan could have maintained a solid scanning service simply by adding Panorama HFO and keeping its fixed 1.5T system. "We could have chosen a more standard MRI configuration, but we believe that 3.0T is becoming the new 1.5T," Ferrier says. "We wanted to be the first to bring 3.0T to our market and patients in this area. Our expectations of a much wider patient/case demographic with 4 Tesla (Achieva 3.0T plus 1-Tesla Panorama HFO) have been borne out fairly rapidly.

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Aug 13, 2007

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Best Practice
Achieva 3.0T X-series, Panorama HFO
Release 2
Pulsar, Quasar Dual
1.0T, 1T, 3T, Brain, IAC, Knee, Musculoskeletal, Neuro, Shoulder, Vascular, Wrist

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