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Rolling Oaks Radiology in second year with workhorse Achieva 3.0T

Best Practice
Gottlieb, Roy, D.O. Thousand Oaks, Rolling Oaks Radiology USA

The perception of radiologists at Rolling Oaks Radiology (Thousand Oaks, Calif. USA) that a 3.0T system would be unique in their market and a top clinical performer in all imaging applications was wellfounded. In the summer of 2005, a major acquisition of Philips equipment included Achieva 3.0T, PET and CT systems and nuclear medicine, ultrasound, digital x-ray and mammography units - transforming Rolling Oaks into a Philips luminary site. The Achieva 3.0T acquisition, in particular, highlights how a private, entrepreneurial scanning facility such as Rolling Oaks Radiology can thrive, harnessing an unfamiliar MR platform and turning it into their workhorse system for all patients and applications.
 Roy Gottlieb, D.O., medical director at Rolling Oaks Radiology Rolling Oaks Radiology
Roy Gottlieb, D.O., medical director at Rolling Oaks Radiology
Rolling Oaks Radiology

Rolling Oaks Radiology finds system a top performer for myriad applications

Constrained by their former medical group into accepting the bare minimum in terms of MR technology, four radiologists founded Rolling Oaks Radiology, a center whose mission was to acquire only the most advanced equipment for the benefit of their patients. In the summer of 2005, a major, multi-modality Philips equipment acquisition, which included an Achieva 3.0T system, marked Rolling Oaks Radiology's official establishment and its new status as a Philips luminary site.


"I thought the neuro images and the cartilage images were spectacular," says Roy Gottlieb, D.O., medical director at Rolling Oaks Radiology and one of the center's current staff of five fellowship-trained radiologists. "I also have a friend that works on 3.0T systems in Florida who is happy from a musculoskeletal standpoint. So, I thought the future was trending toward 3.0T, and making a big investment like this we wanted to look to the future."

Cartilage characterization benefits most in joint imaging

Musculoskeletal studies account for 40 percent of Rolling Oaks Radiology's patient volume, and the potential for major resolution increases with Achieva 3.0T has made a major impact, Dr. Gottlieb observes. "One of the best things about the 3.0T is the resolution we can get imaging the glenoid labrum in the shoulder," he says. "We're able to see labral tears, such as Bankhardt and SLAP tears, without intraarticular contrast. In patients with instability in the shoulder, we see labral tears a lot more on the non-contrast studies than we would have on our 1.5T system.


"This seems to hold true for all the joints and looking at the ligaments of the wrist and the triangular fibrocartilage complex," Dr. Gottlieb continues. "We find that we have a better depiction of small parts because we're able to increase resolution."


In the knee, he adds, certain chondral pathologies are better appreciated, improving the ability to gauge the severity of pathology. "We have been asked to collaborate on a study testing certain drugs' ability to improve the health of underlying cartilage as depicted by the progression or regression of the degree of cartilage thinning/chrondromalacia," he says. "Before we had 3.0T, we could say there was some chondromalacia - perhaps judge more accurately between full-thickness and non-full-thickness. But now, we feel that we have a better depiction - within percentages - 25 to 50 percent, or 50 to 75 percent - to more finely grade chondral thickness changes and even early chondromalacia changes, such as fraying. You really need high resolution for that."

 Patella cartilage tear.
Patella cartilage tear.

3.0T neuro studies predictably better

Studies of the brain and spine represent 30 percent of Rolling Oaks's patient volume and include a range of examinations from routine brain studies to advanced scans such as BOLD fMRI and spectroscopy. The increased SNR provided by the 3.0T field strength enables clinicians to boost resolution and acquire very thin slices.
 Brachial plexus neurofibromatosis
Brachial plexus neurofibromatosis

"We obtain exceptional gray/white differentiation and can see the tiny nerves that come from the brain stem," he says. "We also can better visualize detailed structures, such as potential tiny intracannilicular acoustic neuromas involving the 7th-8th nerve complex even without the use of contrast agents, because of the high spatial and contrast resolution we now obtain using the 3.0T magnet." As expected, MRA at 3.0T is superb via a combination of high field strength and the Philips 16-channel NeuroVascular coil. "We can complete a whole neck study and then an MR angiogram from the circle-of-Willis to the aortic arch without changing coils," Dr. Gottlieb says.


Anecdotally, Rolling Oaks has had success with BOLD fMRI and spectroscopy. In preparation for research studies with the University of Southern California (USC), Rolling Oaks is gaining experience in BOLD fMRI. One project focuses on the functional imaging of children with sickle cell anemia while another independent project explores how BOLD fMRI might guide Gamma KnifeĀ® surgery.


"Gamma KnifeĀ® surgery uses multiple convergent beams of ionizing radiation to treat brain tumors non-invasively, but precise functional imaging data could help USC neurosurgeons create even more focused treatment isocenters, helping to further minimize the dose to eloquent cortex," he says.


Like many other centers, Rolling Oaks also is interested in investigating how MR spectroscopy, an application that demands high SNR, could benefit post-therapy follow-up studies and has used the technique in a few patient cases so far.


"Patients return for follow-up scans and may be having some new symptoms that could be indicative of recurrence of their brain tumor," Dr. Gottlieb explains. "Sometimes it's very difficult to differentiate between radiation necrosis and recurrent or residual tumor on contrast enhanced MRI. With MRS, we can often distinguish these conditions. The quality of our spectroscopy is better on our 3.0T system than it was on our 1.5T system."

Higher resolution helps 3.0T abdominal studies

Rolling Oaks Radiology leverages Achieva 3.0T system's higher SNR to both increase resolution and decrease breathhold times in abdominal studies. This strategy has worked well in breathhold diffusion studies to view possible lymphadenopathy or lesions in the abdomen and pelvis, Dr. Gottlieb notes.


"Our breathhold diffusion sequence provides very good contrast resolution, making areas of restricted diffusion appear white," he says.


"All in all, the 3.0T field strength, and Achieva 3.0T in particular, has proven to be the right selection for us and our patients."


 Post-contrast CT Post-contrast CT MPR CT
Post-contrast CT
Post-contrast CT
Liver masses are better visualized by 3.0T MRI than by 64-slice CT.

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Dec 20, 2006

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Best Practice
Achieva 3.0T
Release 1, Release 2
Quasar Dual
Body, Brain, Knee, Liver, Musculoskeletal, Neuro, Shoulder

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