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Panorama HFO ideal for fetal and pediatric scans

Best Practice
Papaioannou, Georgia, M.D., Ph.D. Athens, Mitera Hospital Greece

Mitera Maternity and General Hospital (Athens, Greece) is home to the largest pediatric unit of any private hospital in Greece. It's also a general hospital with a busy radiology department that uses the Panorama HFO scanner as its sole MR system. The wide range of the 330 pediatric and adult exams performed on Panorama each month include neuro, abdomen, musculoskeletal, angiography, mammography and cardiac.
 Georgia Papaioannou, MD, PhD
Georgia Papaioannou, MD, PhD

Mitera utilizes High Field Open for all MR scans in hospital, from fetal to adult

Georgia Papaioannou, MD, PhD, Consultant Pediatric Radiologist at Mitera, says the Panorama's biggest advantage is its 360-degree openness. "The examinations are quite pleasant for all of our patients, no matter what their age or size. They are provided with a comfortable diagnostic examination with very high image quality. Our anesthetists are also happy when giving medication to our younger patients, because they have room for their equipment, and can still reach the child comfortably."

Oncology work benefits from high-performance system

With image quality comparable to a 1.5T system, Panorama can help detect lesions in all parts of the body. Although oncology work is not the hospital's main focus, Dr. Papaioannou says many of the adult and pediatric cases she sees are oncological in nature.

"The majority of our adult oncology cases are gynecology cases, such as cervical, endometrial and ovarian lesions and breast lesions. We've also seen several cases of soft tissue tumors in the extremities and the abdomen. In addition, we've diagnosed renal cell carcinomas, metastatic and primary tumors of the liver."

"We deal with pediatric oncology cases as well, both congenital and acquired," she adds. "We've seen CNS gliomas, optic gliomas, benign glioneuronal tumors, rare cases of pineoblastoma and giant cell tumor of the ethmoid cells, hepatic, renal and musculoskeletal tumors. As you can see, our Panorama excels in a wide variety of oncology-related scans with high-quality images on the abdominal area as well."

Superb images in pediatric and fetal scans

Among Mitera's pediatric cases, almost half are neuro scans. "We may scan pre-terms or neonates to evaluate neurologic deficits as suggested by their clinical evaluation, or very low birth-weight preterm babies with sonographic and neurologic findings before they go home. We commonly scan children with seizures, headache, visual deficits or hearing loss." The remaining pediatric exams are mainly head and neck, abdominal and musculoskeletal.

Since installing the Panorama two and a half years ago, Dr. Papaioannou says Mitera has performed approximately 130 fetal MRI scans, with great results. "Usually there is an indication from the obstetric ultrasound; the majority are ventriculomegaly (dilatation of the ventricular system in the brain), where our role is not only to confirm the ultrasound findings but to look for additional anomalies that may alter the prognosis of the fetus. We've seen several cases of corpus callosum agenesis and anomalies of the posterior fossa. Fetal exams, especially neuro, may become quite demanding, and the Panorama is really ideal for this type of scan with its large opening, which makes the scan a comfortable experience for the mother-to-be and the very good image quality which produces diagnostic results."

View Clinical cases:

Panorama shines in special applications

In high-end studies such as angiography, enterography, urography, and even cardiac imaging, Panorama's higher field strength is a significant advantage.

"We perform angiography in adults and children, in cases where we feel it enhances the diagnosis," says Dr. Papaioannou. "We don't yet have vast experience in MR angiography, but in the studies we've performed, we've been very happy and our tendency is to replace where possible the CTA with MRA; the Panorama works very well for this."

Mitera Radiology Department has performed several enterography (MRE) scans to evaluate the small bowel in children and adults with known or investigated inflammatory bowel disease. MRE helps visualize the extent and activity of the disease and its associated complications such as abscesses or fistulas. In MR urography, the Mitera Radiology team uses anatomic sequences, 3D images of the urinary tract and dynamic scans for a complete diagnostic picture of the urinary system, its anatomy, and function.

One of Mitera's strong suits is cardiac, and the hospital wanted to assist the cath lab for the benefit of its pediatric patients. To that end, the Mitera Radiology team recently began cardiac MR imaging on their patients. "The initial results of cardiac imaging on the Panorama are quite encouraging and rewarding," Dr. Papaioannou says. "We hope to continue and even expand this program in the future."

Ambient Experience helps enable successful scans

Mitera makes good use of Ambient Experience (AE), which projects sound, lights and pictures into the scanner room to help calm and comfort the patient. "We have seen that it makes our patients feel more relaxed and calm throughout their scanning experience," says Dr. Papaioannou. "We have scanned several claustrophobic patients who had previously tried to be scanned in other systems with no success. We recently scanned a patient with multiple myeloma in her thoracic and lumbar spine, who told me after the scan that it was a fantastic experience. Listening to the music made her think of nice places she had visited previously, and kept her calm. She was quite happy and optimistic after the scan!"

"Ambient Experience also makes a difference in young children, because they are so relaxed in the Panorama," she says. "We also have the MRI kitten scanner for children so they can pretend to 'scan' toys on a small model of a scanner before they enter the room for their own scan. This especially helps children in the borderline ages of five or six."

The Panorama's wide patient aperture accommodates larger patients as well, and when combined with AE it encourages very successful scans. "We have successfully scanned patients that were very big, and could not fit in a regular scanner," Dr. Papaioannou notes. "It has also helped our pregnant patients to feel more comfortable during fetal and maternal scanning. It really makes a difference."

Possibilities for future applications

Mitera has built a success story on the effectiveness of its fetal and pediatric exams, and several other hospitals around the world are sending staff members for site visits. "Our experience with the Panorama HFO has been very satisfying," concludes Dr. Papaioannou. "We hope to continue with even more possibilities for other applications in the future. One of these may be a specially designed coil for neonates and infants, similar to the 16-channel pediatric coil applied for Achieva. Additionally, the design of a mirror-system that could be adjusted on the head-coil so as for the patient to be able to watch the AE projections during the scan may improve our applications."

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Jan 4, 2011

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Best Practice
Panorama HFO
Release 2.5, Release 2.6
Abdomen, Ambient Experience, Body, Brain, Cardiac, Fetal, Musculoskeletal, Neuro, Oncology, Pediatric, Vascular

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