RPS 1414 - Improving magnetic resonance imaging practice

Purpose:

To review current cardiothoracic applications of time-resolved magnetic resonance angiography (TR-MRA) sequences, focusing on contrast agent (CA) protocols, adopted technical parameters, and acquisition schemes.

Methods and materials:

A systematic search of the literature (Medline/EMBASE) was performed in May 2019 to identify articles utilising TR-MRA sequences. The study design, year of publication, population, magnetic field strength, type, dose and injection parameters of CA and injection, and technical parameters of TR-MRA sequences were extracted.

Results:

Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles and the study population ranged from 5-185 patients for a total of 506 patients who underwent cardiothoracic TR-MRA. Magnetic field strength was 1.5T in 13/16 (81%) and 3T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (Multihance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), and gadofosveset trisodium (AblavarTM) in 1/16 (6%). CA showed highly variable doses among studies: a fixed amount or based on patient body weight (0.02-0.2 mmol/kg) was injected with a flow rate ranging from 1-5 mL/s. Sequences were “TWIST” in 13/16 (81%), “TRICKS” in 2/16 (13%), and “CENTRA” 1/16 articles (6%).

Conclusion:

Results identified that a variety of technical approaches were adopted throughout different studies, highlighting a lack of standardisation and consensus. TR-MRA sequences are currently adopted in different clinical settings with different technical approaches, mostly due to different CA dose and type. Further studies are warranted in order to establish appropriate parameters for TR-MRA, especially in relation to CA protocols.

Limitations:

No quality assessment was performed in the included studies.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To investigate radiographers’ compliance with guidelines in assessing CT and MRI referrals and determine factors that influenced their performance.

Methods and materials:

5 referral scenarios for each of CT and MRI were distributed to radiographers who volunteered at the EFRS Research Hub at ECR 2019. A web-based data collection tool designed by Ziltron Ltd was used. The radiographers were required to determine the appropriateness of each referral, highlight any concerns, and recommend suitable alternative investigations if applicable. An overall performance score from 0-5 was calculated and a linear regression analysis was used to determine factors that influenced the radiographers’ performance.

Results:

91 (n= 5I CT, n=40 MRI) radiographers participated. 58% and 57% of responses were consistent with recommended guidelines for CT and MRI, respectively. Possession of an MSc qualification in CT was a significant predicting factor of consistency with the guidelines (p=0.02). Being a radiographer in a lead professional role and/or an educator was a significant predicting factor for a greater consistency with the guidelines (p=0.01) in MRI, and approached significance for CT (p=0.06). The routine use of referral guidelines was reported by 80% of participants.

Conclusion:

Over 50% of the radiographers’ responses complied with guidelines.

Limitations:

There may be a selection bias as participants were ECR 2019 attendees and predominantly working in Europe. Caution in translating the outcomes beyond this cohort is warranted. Additionally, the referral cases were designed with minimal text to enable easy comprehension for non-native English participants, however, the impact of language must be considered.

Ethics committee approval

Ethical approvals were obtained from the UCD Institutional UREC in Ireland and NSD (reference number 776616) in Norway.

Funding:

No funding was received for this work.

Purpose:

To assess if the image quality from cervical and lumbar spine MRI examinations meets the quality criteria previously established in a radiology department.

Methods and materials:

A retrospective study was conducted in a public radiology department using a random sample of 450 cervical and lumbar spine MRI examinations grouped in 15 smaller samples, each one with 30 exams. Using a quality criteria checklist organised into 4 main groups, the conformities and non-conformities found were recorded and used to establish 3 types of quality control chars: the proportion of conformities and non-conformities (p chart), the total number of non-conformity exams (np chart), and the total number of non-conformities in each sample (c chart), in order to suggest corrective actions for improvement.

Results:

Considering all exams, 289 were classified as conforming (64.22%) and 171 were classified as non-conforming (38%). Considering the non-conform exams group for the cervical spine, the quality criteria “motion artefacts” presented the highest number of non-conformities (55.56%), followed by “aliasing artefact” (31.11%). For the lumbar spine non-conform exams group, the quality criteria “cross-talk artefact” presented the highest number of non-conformities (45.59%), followed by “aliasing artefact” (21.32%) and “motion artefacts” (20.59%).

Conclusion:

The existence of suitable quality control of the image is essential to achieve high-quality standards. Strategies for improving radiographers performance and scientific knowledge must be implemented to ensure that spine MRI examinations are performed in compliance with all the quality criteria established. Therefore, it is essential to implement a checklist for a systematic evaluation based on a quality control program.

Limitations:

n/a

Ethics committee approval

The ethics committee approved the study.

Funding:

No funding was received for this work.

Purpose:

To develop updated recommendations that are evidence-based to perform simulations as a strategy to prepare paediatric patients for MRI examinations when reducing the use of sedation.

Methods and materials:

A systematic review using the Joanna Briggs Institute system for unified management (JBI SUMARI) was performed to identify studies published after 2010. Sedation, anxiety, paediatric*/child, mock MRI/play therapy were included in the search using a 6S model. The databases consulted were National Guidelines Clearinghouse, Nice, HealthEvidence, JBI, Cochrane, Uptodate, Tripdatabase, PubMed, Cinhal, and Google Scholar. 3 independent reviewers assessed articles and Gradepro software was used to rate each recommendation.

Results:

5/266 articles were selected. One was a systematic review, 2 were randomised controlled trials, and 2 were quasi-experimental and observational studies. 2 recommendations graded as B came up: paediatric patients’ preparation with an MRI simulation is efficient between 4 and 11 years old. The relative risk of sedation was reduced to almost 50% for patients prepared with a simulated MRI compared to those without preparation. A modified Yale preoperative anxiety scale (mYPAS) test was suggested as a tool to select patients that can be exposed to a simulation when the score is less than 33.

Conclusion:

The simulation of an MRI to prepare paediatric patients for this examination is a strategy that can work, but only in specific circumstances and mainly for an age superior to 4 years old. Simulation can reduce anxiety, ensuring a successful examination without sedation. Further studies, however, should be conducted to very if this strategy can be applied to other imaging modalities even using the same simulation setting.

Limitations:

Only a few studies were available.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To compare the image quality of single breath-hold (BH) three-dimensional (3D) MRCP using GRASE with that of the compressed sensing (CS) technique.

Methods and materials:

We retrospectively identified 44 patients with hyperintense bile on T1-weighted fat-suppressed images who underwent BH 3D MRCP using both GRASE and CS with a 1.5T scanner. Maximum intensity projection MRCP images were reviewed for visibility of the right, left, and common hepatic duct, common bile duct, gallbladder (GB), cystic duct, and pancreatic duct (PD), motion artefact, background suppression, and overall image quality using a 5-point scale (1=poor; 5=excellent). The scores and availability rates, the latter defined as a visibility score of ≥3, were compared between GRASE and CS using a Wilcoxon signed-rank test and McNemar’s test, respectively.

Results:

The median visibility scores of each biliary segment were significantly higher in GRASE than CS (p≤0.001 for all). No significant difference was found for the PD (p=0.396). The motion artefact score was not significantly different (p=0.313). GRASE had significantly lower background suppression scores (p<0.001) and higher overall image quality scores (p<0.001) than CS. GRASE had significantly higher rates of availability on the basis of visibility of the GB (44/44 vs 29/44, p<0.001) and cystic duct (39/44 vs 19/44, p=0.001) than CS. Similar but non-significant trends were observed for the other biliary segments.

Conclusion:

BH 3D MRCP with GRASE provides better image quality and higher availability for depiction of the biliary ducts than CS in patients with hyperintense bile on T1-weighted images.

Limitations:

Non-consecutive patients might lead to a selection bias.

Ethics committee approval

IRB approval was obtained and informed consent was waived.

Funding:

No funding was received for this work.

Purpose:

Multiple artefacts can cause variation in the calculated apparent diffusion coefficients (ADCs) for defined anatomical regions, resulting in unreliable quantification in DW MRI. The appropriate selection of parameters and phase-encoding (PE) direction are essential to minimise artefacts. The aim of this preliminary study was to evaluate the impact of PE-orientation on mean ADC for normal bone marrow at sites associated with ACL injury-related bone bruising.

Methods and materials:

A standard knee protocol and optimised axial-DWI sequences acquired with the same parameters except for the PE-direction (anterior-posterior (AP) and right-left (RL)) were performed on 15 healthy individuals (18-35 years). For each subject, 30 50mm2 regions-of-interest (ROIs) were placed on locations associated with ACL-related bone bruising: anterior, medial, and posterior ROIs in the medial and lateral tibial condyles (TC) and medial and lateral femoral condyles (FC). Mean ADC values were calculated and the effect of PE-direction (AP vs RL at b50_600s/mm2and b50_ 800s/mm2) was evaluated.

Results:

The calculated mean ADC for all ROIs with an AP PE-direction was higher than RL PE-direction (diff=0.0066; SE=0.005) for b50_600s/mm2 and marginally lower (diff=0.0007; SE=0.007) for b50_800s/mm2. In the FCs, the effect of AP PE-direction was higher than the RL PE-direction by 0.019 (b50_600s/mm2) and by 0.0398 (b50_800s/mm2). The mean ADC was marginally lower in (TCs) by -0.005 and -0.025 for both b-value image sets. These results indicate marginal and non-statistically significant differences in mean ADCs for DWIs acquired in two PE-directions (p=0.11).

Conclusion:

For healthy volunteers, the use of an AP or RL PE-direction has a minimal impact on ADCs, however, mean ADCs may be affected by changing the PE-direction in subjects with ACL-related bone bruising or ACL reconstructions, which will be evaluated in further research.

Limitations:

n/a

Ethics committee approval

Institutional ethical approval obtained.

Funding:

Part-funded by the Kuwait Cultural Office.

Purpose:

The improvement of results in healthcare through the transmission of information to the patient using empathy and trust is already a verified hypothesis. Healthcare professionals should base themselves on interpersonal competencies throughout their daily work routine to promote quality in medical imaging, patient safety, and technical excellence. The aim of this study was the exploration of the patient’s perceptions regarding the performance of radiographers in terms of interpersonal communication skills during MRI procedures.

Methods and materials:

The instrument used was the questionnaire “communication assessment tool” (Makoul et al. 2007) adapted to the professional reality of radiographers. 110 valid questionnaires (including 15 questions with a 5-point Likert scale) from patients aged from 18-85 years old were conducted. The paper-based instrument was delivered and filled by the patients after the performance of MRI procedures in 2 public hospitals.

Results:

The internal consistency of the questionnaire was excellent (Cronbach's alpha=0.964). The highest ratings were for radiographer behaviour items, such as “used an accessible language" (4.62), “respect for the patients” (4.58), and “he paid attention to me” (4.53). The lowest ratings were “encouraged to make questions” (3.88), “involved patients in decision-making process” (4.06), and “talk with patients about the next following steps” (3.81).

Conclusion:

Radiographers communication skills were evaluated with good levels of patient confidence with the MR examinations. Despite the overall positive results, this area of health service delivery must be accorded the attention it deserves to continually improve patient satisfaction through improved communication.

Limitations:

The sample size.

Ethics committee approval

The ethics committee approved the study and written informed consent was obtained.

Funding:

No funding was received for this work.

Purpose:

To explore specific MRI safety policies in Greece and compare them with the recommendations of the American College of Radiology (ACR). The null hypothesis was that there are no significant differences between the safety policies employed in Greece and the ACR's safety guidelines.

Methods and materials:

All the MRI units currently operating in Greece were included in this study. Census sampling method was used. This resulted in a sample size of 307 MR scanners, operating both in a public/private or inpatient/outpatient environment. A specific questionnaire was distributed to the participants, with pre-coded closed questions. Statistical analysis was performed on IBM Spss statistical software, version 24.0. Descriptive statistics were performed to analyse the results. Pearson's Chi-square test was used to measure possible relationships between variables.

Results:

Out of 307 MR scanners, 104 valid responses were received. The response rate was 33.87%, while the level of statistical significance was p<0.05. The margin of error was 7.9 percentage points at the 95% confidence interval. Cronbach's alpha coefficient was 0.686.

Conclusion:

Greek MRI units reported a relatively good level of compliance with the recommendations of the ACR. However, a high lack of MR safe equipment was noticed, as well as some inconsistencies regarding the optimal zoning system. Specific safety measures are recommended to enhance MRI safety in Greece. Further research is needed.

Limitations:

The item non-response bias. The generalisation of the results cannot be achieved due to the relatively low response rate.

Ethics committee approval

Written informed consent was obtained. Approval was given from the scientific committees of all public hospitals in line with the Greek legislation.

Funding:

No funding was received for this work.

Purpose:

There are risks and hazards related to MRI examinations. Therefore, it is extremely important to ensure both professionals and patients' protection from MRI risks and hazards. MRI risks and hazards professionals' knowledge is crucial for better practices.

The main purpose was to evaluate the knowledge about MRI safety of radiographers and medical physicians (radiology and neuroradiology), considering their experience, education, and background.

Methods and materials:

This study was directed to radiographers and medical physicians working in public, private, and public-private institutions through an online questionnaire with 20 questions. The analysis of the influence of the experience in MRI was made with a Student t-test for independent samples and a Mann-Whitney test. Statistical analysis of the influence of extracurricular formation on MRI was performed using the ANOVA test.

Results:

128 complete replies were obtained, 102 from radiographers, 15 from radiologists, and 3 from neuroradiologists.

It was found that MRI experience and education were statistically significant (p≤0.05) in concerns about MRI safety knowledge when compared to professionals without MRI experience and education.

Conclusion:

This study focuses on the impact of continuing education, highlighting the importance of training dedicated to the area of professional performance related to MRI safety.

Limitations:

The sample could be bigger.

Ethics committee approval

n/a

Funding:

No funding was received for this work.