A recent IMV market report stated that, in 2017, about 35 million magnetic resonance imaging (MRI) scans were performed in the United States. Although this number appears to be large, it is an 8 percent decrease over MR scans conducted in 2016. This reduction was observed to be because of a drop in the diagnostic procedure performed in non-hospital locations.1
With the world’s aging population projected to double by 2050 to nearly 2 billion elderly people,2 it is expected that patient throughput (meaning the flow and cycling of patients in health settings) will increase.3 This increase could quickly evolve into a healthcare delivery crisis if certain long-standing issues are not tackled.
Specifically, the slow rate of speed of MRI scanning. MR systems in clinics and hospitals have come a long way in terms of technology and image resolution in the last 15 years. However, lack of improvement to the speed of the scan is causing concern for imaging providers, in terms of low patient inflow. This is true even in cases where healthcare providers have upgraded to more advanced machines like the 3.0T systems.4
This brings us to a pertinent question — can faster MRI technology solve the issue of patient throughput in radiology departments of hospitals?
Current Challenges in MR Imaging
In today's modern healthcare system, all stakeholders involved are looking for progress. For example, patients are demanding better outcomes, healthcare providers are looking for more efficient and less expensive processes, and state governments are striving for healthcare improvements for society at lower costs. A paper by O’Brien et al. has delved into this subject and found that a smoother integration of these stakeholders naturally comes with a price, whether in the form of quality, productivity, or costs.5
As technology has continued to advance, MRI systems and processes have continually been revamped to address patient value rather than the conventional “volume-based” method (i.e., where importance was given only to the number of scan-patients). This has caused radiology professionals to concentrate on improving operational efficiency and value delivery5,6, along with processing time.
MRI technologists at the Howard County General Hospital, a subsidiary of John’s Hopkins, said that they see issues with patient throughput every day. On one hand, doctors and nurses claim to refer a certain number of patients for MR scans, but on the other end, scanning tables were, surprisingly, empty when it came to it. This indicated that there was a problem in streamline of flow among the different departments, or that patients opted out of the test for some reason. They also observed that, in some cases, many (more than 20) patients were given wait times of up to 9 hours!7
Overcoming MRI Time-Related Challenges
MRI examinations have a complex workflow with respect to scheduling, monitoring, and performing the scan. A solid operations strategy is critical in hospital environments, in order to manage the growing demand for medical imaging. Some studies suggest MRI process improvements that simultaneously reduce patient wait times and increase the volume of daily completed MRIs9.
One study conducted in 2017 described how there is often a big difference between the time allotted for the scan, and the actual time required for imaging procedures like MRI. With the help of a multidisciplinary team, and after refining the scanning process by focusing on lean principles, the team found that the costs-per-scan decreased and patient throughput was more optimized. This method also created better patient experiences.5,10
In addition, during a brainstorming session at John's Hopkins, it was agreed that the highest priority for boosting throughput was the early screening of patients. If this process was performed by units other than the radiology department, it could ease the burden of MRI techs and streamline the flow. Accordingly, this pilot study revealed a 35 percent decrease in throughput times and increased satisfaction from patients.7
Furthermore, a commentary published online in Imaging Technology News (ITN), described two factors that they believed could bolster patient throughput; improved waiting room facilities and proper staffing in examination rooms. ITN stated that even the fastest MRI scanners could not improve patient throughput if there were operational issues in the waiting room and examination room. For example, if an MRI system could complete a scan in only 15 minutes, but the next patient in line was not prepped properly, then there are more challenges to overcome than just incorporating a technologically enhanced MRI system.4
Another challenge with speeding up patient throughput occurs when scanning pediatric patients. This is no easy feat as some MRIs are lengthy procedures that require patience and tolerance from children. A few years ago, radiologist Shreyas Vasanawala and his team at Stanford University developed a state-of-the-art MRI system, designed specifically for pediatric use, which reduced the amount of the time required for a child to undergo a scan. They did this using a method called compressed sensing, which enables the collection of only a small amount of data, in a short span, from the patient. This information will consequently be reconstructed into a complete MR image at a later time.8
The Department of Radiology at Brigham Health in Boston has also recently made small alterations by way of updating their MRI systems instead of changing the entire unit or the magnets involved. These adjustments helped shorten protocols and resulted in better image quality, faster scan times, and thus, happier patients. The entire program was labeled as a success.11
A question posed by a manager at one of the health centers in the United States, was, “If you or one of your family members were going through treatment, how would you feel about waiting 9 hours for an MRI exam?”.7 This certainly drives home a very important sentiment for hospitals, patients, and their families.
With the release of new technologies, powerful imaging modalities such as MRI are making waves and diagnosing health and disease more effectively and accurately. In the last decade many faster and smarter MRI machines have been cleared by the FDA for use in healthcare settings. Maybe in the future, they could play a more prominent role in delivering quality care to patients while maintaining an ideal throughput at the same time.
- 2017 MR Market Outlook Report, IMV, https://imvinfo.com/product/2017-mr-market-outlook-report/, (accessed 22 Jul 2018)
- World Population Aging, 2017, United Nations Organization, http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf,(accessed 22 Jul 2018)
- Patient Throughput: A Critical Strategy for Success, 2007, The Chartis Group, http://www.chartis.com/resources/files/whitepapers/pre-2013/chartis_group_patient-throughput-critical-strategy-for-success.pdf, (accessed 23 Jul 2018)
- MRI Technology and Throughput, 2012, Imaging Technology News, https://www.itnonline.com/article/mri-technology-and-throughput, (accessed 22 Jul 2018)
- O’Brien, J. J. et al. (2017), Optimizing MRI Logistics: Focused Process Improvements Can Increase Throughput in an Academic Radiology Department, American Journal of Roengenology, 208 (2), Pp 38-44
- Imaging 3.0, American College of Radiology, https://www.acr.org/Practice-Management-Quality-Informatics/Imaging-3, (accessed 23 Jul 2018)
- Rethinking Throughput, 2016, American College of Radiology, https://www.acr.org/Practice-Management-Quality-Informatics/Imaging-3/Case-Studies/Strategic-Planning/Rethinking-Throughput, (accessed 23 Jul 2018)
- Advanced Technologies Vastly Improve MRI for Children, 2014, NIH, https://www.sciencedaily.com/releases/2014/09/140909092117.htm (accessed 23 Jul 2018)
- Wessman, B. V. et al. (2014), Reducing barriers to timely MR imaging scheduling, RadioGraphics, 34, Pp 2064-2070
- Boland, G. W. et al. (2014), Delivery of appropriateness, quality, safety, efficiency and patient satisfaction, J Am Coll Radiol, 11, Pp 7-11
- MRI upgrade proves successful by providing better image quality, faster scan times and more satisfied patients, 2018, Brigham Health, https://www.brighamandwomensfaulkner.org/about-bwfh/news/mri-upgrade-proves-successful-by-providing-better-image-quality-faster-scan-times-and-happier-patients, (accessed 23 Jul 2018)
- Recent Advances in MRI Technology, 2016, Imaging Technology News, https://www.itnonline.com/article/recent-advances-mri-technology, (accessed 23 Jul 2018)