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Achieva 3.0T sharpens competitive edge at Urania Diagnostic Center

Best Practice
Drahanowsky, Wolfgang, M.D. Vienna, Urania Diagnostic Center Austria

Achieva 3.0T sharpens competitive edge at Urania Diagnostic Center, Vienna

As a free-standing, independent imaging center, Urania Diagnostic Center (Vienna, Austria) can't afford to scan at the pace of some of its competitors, largely university-affiliated clinics where cash flow isn't as critical.When a move to new facilities was the motive to acquire new MRI equipment in 2004, Urania selected the Achieva 3.0T system. In its first eight months of operation, Achieva 3.0T had scanned 7,000 patients. Urania radiologists soon discovered that Achieva 3.0T's speed combined seamlessly with superb image quality, making Urania more competitive than ever, according to Urania co-owner Dr.Wolfgang Drahanowsky.
 Dr. Wolfgang Drahanowsky Urania Diagnostic Center High resolution 3D WATS/ProSet clearly depicts
intact cartilage surface over a transchondral fracture of the
talar dome. Note also concurrent fibular fracture.<br><br>
Dr. Wolfgang Drahanowsky
Urania Diagnostic Center
High resolution 3D WATS/ProSet clearly depicts intact cartilage surface over a transchondral fracture of the talar dome. Note also concurrent fibular fracture.

Austria's first 3.0T system delivers superb image quality at 4-patient-per-hour pace

In 2004, the centerpiece of the Philips multi-modality imaging equipment proposal for Urania Diagnostic Center was the Achieva 3.0T. Philips' offer was attractive, but Urania radiologists needed assurance that Achieva 3.0T would deliver what they needed.

 

"With 40 mostly 1.5T MR scanners in Vienna, competition is intense. The main point for us was to acquire a machine that would provide very high quality images, while at the same time giving us high patient throughput," says Wolfgang Drahanowsky, M.D., one of Urania's four owners. "We needed proof that the 3.0T system would be able to realize this easily in a private practice setting."

 

A trip to a Zurich-based Achieva 3.0T site dispelled concerns about the system's ability to wed speed with image quality. "Like many academic centers, this site wasn't focused on using Achieva 3.0T for high throughput," Dr. Drahanowsky recalls. "But we discovered very soon that you can really speed it up with 3.0T. I think we did the first knees in the world using higher SENSE factors."

 

Philips won the multi-modality order on the strength of Achieva 3.0T, which became operational in October 2004. Today, the system scans between 35 and 40 patients per day - one study every 15 minutes - predominantly neuro cases (27% brain, 25% spine), in addition to smaller numbers of orthopedic, abdominal, breast, pediatric and miscellaneous cases.

 

"We do a few more patients a day, but the main point is we brought up our quality significantly," he says. "And we continue to do so while staying within our time constraints. All of a sudden we're getting many visitors and they can't believe what they see regarding image quality and speed. 3.0T sets new standards in imaging the brain and joints and in MRA."

 


 

  Femoral cartilage imaging. Various stages of femoral chondromalacia / chondral defects as

  seen on Urania's standard coronal PD SPAIR sequence with the 8-channel SENSE Knee coil, scan

  time 1:45 min. Exact staging of femoral cartilage lesions is now possible in this low

  measurement time.

 Normal. Localized full thickness cartilage defect.
Normal.
Localized full thickness cartilage defect.
 Loose osteochondral fragment. Slight thinning of femoral cartilage after partial meniscectomy.  Severe osteochondral lesion with subchondral cystic changes.
Loose osteochondral fragment.
Slight thinning of femoral cartilage after partial meniscectomy.
Severe osteochondral lesion with subchondral cystic changes.

 


 

  Patella cartilage imaging. Various stages chondromalacia / chondral defects as seen on

  Urania's standard axial PD SPAIR DRIVE sequence with the 8-channel SENSE Knee coil, scan

  time 1:31 min. These images images allow exact staging of cartilaginous lesions.

 Localized blister with intact surface. Surface fraying.
Localized blister with intact surface.
Surface fraying.
 Severe thinning of the medial
patellar cartilage surface. subtotal thinning of patellar cartilage. Localized cartilage tear with
subchondral edema.
Severe thinning of the medial patellar cartilage surface.
subtotal thinning of patellar cartilage.
Localized cartilage tear with subchondral edema.

 


 

Neuro applications flourish on doubled SNR

With Achieva 3.0T, Urania clinicians have abundant SNR to employ in neuro sequences that would have been left untried on their 1.5T platform. Thin slices, high in-plane resolutions and fast scan speeds - enhanced by SENSE - are now possible all at once, Dr. Drahanowsky reports.

 

"For instance, 3D sequences have been available for years on 1.5T systems, but in some applications it was difficult to balance spatial resolution and signal-to-noise ratio," he says. "Today, we use that very same sequence with slices one millimeter thick and in-plane resolutions under a millimeter, but at 3.0T the large signal increase gives us high quality images and SENSE delivers them quickly."

 

The same scenario applies to MRA between field strengths, Dr. Drahanowsky adds. "You get nice time-of-flight angios on the 1.5T, but when I compared cerebral MRAs on both systems - using the identical sequence and coil type - at 3.0T I gained vessels as small as 0.5 to 0.7 mm that I didn't see at 1.5T, especially on the MIPs. Now we can reliably detect vessels under a millimeter in diameter."

 


 

 

1.5T 3.0T
1.5T
3.0T

  3D multichunk TOF comparison at 1.5T and 3.0T using the same

  sequence. Arrows point to vessels that can be seen at 3.0T but

  fade out at 1.5T. 125 slices, matrix 368 x 512, SENSE factor 2.5,

  voxel size 0.54 x 0.82 x 1.4 mm3, 3:31 min.

 

 

SENSE is used routinely in virtually every examination at Urania, frequently to increase acquisition speed. Alternatively, in many brain studies, in which extra resolution often is desired, SENSE speed can be traded for increased resolution. "When imaging hippocampal sclerosis, for instance, we go to an in-plane resolution of 0.35 x 0.39 mm2 with 1.0 mm slices," he notes. "These sequences take 6:08 min. and you obtain very good image quality and high resolution. In addition, with highly T2-weighted axial images in the region of the IAC, for instance, we're also seeing tiny lesions such as 1-2 mm potential acoustic schwannomas."

 

Before Achieva 3.0T, Urania faced unwanted constraints when it came to temporal lobe seizure imaging, Dr. Drahanowksy relates. "Being a private center we really couldn't adjust our time limits and take the 40 minutes our university-based competition takes for the 1.5T epilepsy examinations. To stay on schedule we had to acquire images of poorer resolution. That's all forgotten now with Achieva 3.0T, which performs the examination in 17 minutes and provides very high quality examinations that beat any 1.5T study."

 

By May 2005, Urania had integrated 3.0T BOLD fMRI imaging to localize possible epileptic foci. "We have specialized surgeons for seizure surgery and they have been eagerly awaiting these functional studies," he says. Also in spring 2005, Urania was contemplating when to implement DTI for white matter fiber tracking and MR spectroscopy for lesion characterization.

 


T2-weighted TSE High resolution T2-weighted TSE of the hippocampus.  Matrix 688 x 1024, pixels 0.32 x 0.39 mm2, 1 mm slices, 6:08 min. <br><br>Histologic section
T2-weighted TSE
Histologic section
High resolution T2-weighted TSE of the hippocampus. Matrix 688 x 1024, pixels 0.32 x 0.39 mm2, 1 mm slices, 6:08 min.

Impressive below the neck too

Brain and spine cases dominate at Urania, but Achieva 3.0T sees a fair amount of body and orthopedic cases - enough for clinicians to form a very positive opinion of the system's capabilities.

 

"For example, in the pancreas or kidney, the results are wonderful," Dr. Drahanowsky remarks. "We obtain very high resolution using a 1024 matrix in the pelvis routinely and with a very acceptable scan time, which I attribute to our ability to use SENSE. This technique has represented a real quantum leap in pelvic imaging at 3.0T. In all regions we use matrixes higher than 256 now, which we didn't have before."

 

Another leap forward is seen in joint imaging, which is 10% of Urania's case volume, he adds. "Joint and cartilage imaging at 3.0T provides referring physicians with something they couldn't get often at 1.5T," he says. "At 1.5T, patellar cartilage imaging wasn't bad if you used a good sequence and took five or six minutes to scan, which we couldn't do because it took too long. But now, we achieve a much shorter 3.0T scan time using SENSE, and we see surface fraying in the patellar cartilage and a great deal of detail. Femoral cartilage imaging has always been guesswork in my opinion, because this structure is exceedingly thin. Now, we routinely see nicely depicted femoral cartilage defects."

 


 

Single-sh T2-weighted <br>TSE with SPAIR 40 slices of 5 mm, matrix 320 x 512, 55 sec. scan time.Zoomed<br><br> Note the detailed depiction of the cervix.Single-shot <br>T2-weighted TSE 29 slices of 4 mm, matrix 384 x 512, 42 sec. scan time.
Single-sh T2-weighted
TSE with SPAIR
Zoomed

Single-shot
T2-weighted TSE
40 slices of 5 mm, matrix 320 x 512, 55 sec. scan time.
Note the detailed depiction of the cervix.
29 slices of 4 mm, matrix 384 x 512, 42 sec. scan time.

 

 

"Vienna's choice" for advanced imaging

In attracting referrals, the only thing that counts is the diagnostic quality of the examination. After visiting two Philips 3.0T installations, Urania radiologists were convinced that the Achieva 3.0T could be used for routine applications at an economically expedient "workhorse" pace, while also enabling the clinic to maintain the highest image quality amid their many university-based 1.5T competitors.

 

After the Achieva 3.0T became operational, the promise of high speed and image quality was realized very quickly, and after several more months referring physicians knew that Urania was the place to go for highly sophisticated imaging.

 

"Doctors are increasingly sending us difficult cases where they want images that only a 3.0T system can provide before they proceed with interventions," he says. "For instance, they may send a patient with a complex arteriovenous malformation, requiring excellent MRA and high quality T2-weighted images in two or three planes for planning Gamma KnifeĀ« surgery. And we get a lot of specialized referrals now, such as cases of fibromuscular dysplasia, which need highly detailed images.

 

"Clearly, Achieva 3.0T has given us a nocompromise solution, enabling us to match or exceed image quality capabilities of the competition, while not interfering with our time constraints," Dr. Drahanowsky says.



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Best Practice
Achieva 3.0T
Release 1
Quasar Dual
Ankle, Bladder, Body, Brain, Cervical spine, IAC, Kidneys, Knee, Lumbar spine, Musculoskeletal, Neuro, Pancreas, Prostate, Thoracic spine, Uterus, Vascular
 

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