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For other articles and previous issues click here. August 22, 2005 Going
to Extremes A small, extremity MRI system can play a useful role in supporting an imaging department’s growth. Hospitals and imaging centers have used the less expensive systems to meet growing demand before the facility is ready to support a second whole body scanner. What’s an imaging department to do when it needs additional capacity for providing MRI exams? Robert L. Kwolyk and Peter B. Roemer offer a little extreme thinking—extremity thinking actually. “As more and more whole body units were being placed in the market, we saw a need for a specialty type of system as an alternative to purchasing another whole body system, which is very expensive,” says Kwolyk, who is cofounder, president, and CEO of ONI Medical Systems, Inc. Kwolyk and Vice President and Chief Operating Officer Peter B. Roemer, PhD, who spent a combined 28 years working in MRI at GE Medical Systems (now GE Healthcare), partnered and launched ONI to provide dedicated-purpose MRI systems that would offer a 1.0-Tesla (1.0T) open MRI system at one-third to one-quarter the cost of a whole body unit. Further, Kwolyk says the system would take up only one-fifth of the floor space and, most importantly, provide the same image quality as a 1.5T whole body unit. The company’s OrthOne produces extremity images—particularly useful to orthopedic surgeons—such as the foot, ankle, knee, hand, wrist, and elbow. Extremity MRIs represent approximately 25% of all MRI scans performed in the United States. Demand for orthopedic extremity MRI procedures is expected to grow, due in a large part to active lifestyle trends and greater patient awareness of MR imaging. OrthOne enables facilities to off-load this 25% and even increase the volume of extremity exams. In this way, it would serve as a complement to existing MRI units. Freeing the Big Magnet Kwolyk says ONI focused on developing a system that operated comparable to the gold standard of imaging as represented by whole body units, and that would enable facilities to decompress their existing whole body units by off-loading extremity scans. “They could put these scans on our unit, freeing up more scan time for a whole body unit and potentially deferring the need for a site to buy a second, third, or fourth whole-body unit,” he says. Since its introduction in 2002, OrthOne has generated sales among universities, large hospitals, diagnostic imaging centers, and office-based orthopedic practices. Customers have found it to be an effective and cost-efficient alternative. In addition to benefiting from the aforementioned advantages, they find that it offers technique flexibility and fast scan times, as well as strong pulse sequences for contrast-enhanced studies, late echo imaging, and fat-suppressed visualization. Because the unit is DICOM 3.0-compatible, it can be used for teleradiology diagnosis and consultation. Image quality was the most important consideration for ONI, says Kwolyk. In developing the unit, the company was intent on making a system that, in the eyes of radiologists, produced images that would be comparable or equal to that of high-field, whole body units. “That was the minimum requirement we had to meet if radiologists were going to embrace this equipment and put it side by side with their existing whole body unit,” says Kwolyk. “Otherwise, this would not represent any kind of added contribution. By virtue of our installed base, I think that we have satisfactorily addressed that challenge.” Another reason image quality is so high is that OrthOne makes it easier to position patients for extremity imaging. Because OrthOne is designed specifically for orthopedic applications, users don’t need to attach surface coils or other devices to the anatomy. Patients sit in a comfortable chair and their anatomy can always be placed in the isocenter of the magnet. “It gives us the ability to get placement in the so-called ‘sweet spot’ of the magnet, which is so much easier to do than on a big magnet,” says Finn. “This is very important, because your best imaging comes out of that area.” The isocenter imaging results in optimal first-time images that often provide better resolution and information than those produced by high-field whole body MRI systems using surface coils. “As far as extremity imaging, positioning a patient’s hand, wrist, or elbow in a whole body unit is very awkward,” says Kwolyk. “Patients are placed in the magnet on their backs or stomachs and have to extend their arms for prolonged periods of time. That’s especially hard for elderly patients.” Handling Growth Sharon Hanley-DeCoste, Jordan’s director of
CT and MRI services, says the hospital needed more MRI access but
didn’t have the patient population to support the acquisition
of another whole body scanner. “Purchasing the OrthOne provided
a way that we could off-load extremity examinations and maximize
usage of our larger, fixed unit,” she says. “We found
that it would pay for itself just through extremity examinations
and noncontrast work.” Size and available space were also major considerations. DeCoste says it fit in at the off-site setting of the orthopedic practice because of its compact size. All OrthOne components can fit through standard office doorways and onto standard elevators. The unit can fit into an area as small as 165 square feet and weighs just 1,400 pounds. “To accommodate a new whole body system, a facility has to build an MRI suite, which includes not only the scan room but also the equipment room and the technologist area,” explains Kwolyk. “The required square footage encompasses 800 to 1,000 square feet, which is a lot. Our system requires a total space of no more than 200 square feet.” DeCoste says her technologists love the unit because it is easy to learn and use because of its Windows-based interface and intuitive menu-driven screens. OrthOne only takes four keystrokes for a selected predefined protocol to automatically acquire prescribed pulse sequences. Yet, image quality was the deciding factor. “We looked at low field strength orthopedic units and at OrthOne and we decided that, from a quality standpoint, we wanted to be able to have the same quality or comparable quality between exams done on an extremity unit and the whole body MRI unit. So we went with OrthOne,” recalls DeCoste. Quality Images Radiologists at New England Baptist Hospital have used an OrthOne unit for nearly three years. The hospital’s radiology department specializes in orthopedics, and its nine radiologists look at 18,000 MRI exams per year. “OrthOne images are outstanding,” says Finn. “When you talk to any orthopedic surgeon, they’ll tell you that when it comes to the elbow and wrist, the images are superb.” Finn says they found that images acquired by the OrthOne are often of higher quality than those acquired using the hospital’s 1.5T whole body MRI system. With the high resolution provided, radiologists can view detailed images of small anatomy such as ligaments in fingers and wrists, as well as bone marrow, subtle injuries in the elbow, or articular cartilage in the knee. Marketing Possibilities Because OrthOne is small and completely open, Finn finds that it is helpful for claustrophobic patients. The only parts of the body that need to enter the magnet are the parts needing to be imaged. He says, “I’ve had a lot of patients who have had previous MRIs, and when they see this machine, they say, ‘Great, I don’t have to go into a big tunnel.’” Instead of laying on a gurney, they are positioned in an ergonomically designed, movable chair. The OrthOne is also a quiet machine; patients don’t need to use earplugs to block out gradient noise. Its design attributes make it an ideal system for children, who can be intimidated by the sight of a large MRI system. Because the system is far less frightening, few children need to be sedated, and parents can stay at their side during the scanning. Because the OrthOne is attractive to claustrophobic patients and because it can image extremities so well, OrthOne has proven to be an easily marketable service that can bring in more business. Both Jordan Hospital and New England Baptist have seen an increase in patients from outside their immediate service areas. “We’re getting referrals from other places, and from patients who may have claustrophobia, or they want better imaging,” says Finn. “Patients have specifically requested that
their scans be done on the unit,” says DeCoste. Since 2002, ONI has shipped 70 units in the United States and five to Europe. ONI has landed a contract with the U.S. Department of Defense (DOD), who seeks an economical method to relieve the MRI backlog at military hospitals. Specifically, the DOD’s Defense Logistics Agency has signed a supplier contract with ONI, who will provide the agency with systems for all branches of the DOD, including the Army, Navy, Air Force, Marine Corps, and Department of Veteran Affairs. “We are anticipating other DOD orders,” says Kwolyk. — Dan Harvey is a freelance writer based in Wilmington, Del., and a frequent contributor to Radiology Today. |
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