Magnetic Resonance Imaging Technologists Research Articles

Modern acceleration in musculoskeletal MRI: applications, implications, and challenges.

Magnetic resonance imaging (MRI) is crucial for accurately diagnosing a wide spectrum of musculoskeletal conditions due to its superior soft tissue contrast resolution. However, the long acquisition times of traditional two-dimensional (2D) and three-dimensional (3D) fast and turbo spin-echo (TSE) pulse sequences can limit patient access and comfort. Recent technical advancements have introduced acceleration techniques that significantly reduce MRI times for musculoskeletal examinations. Key acceleration methods include parallel imaging (PI), simultaneous multi-slice acquisition (SMS), and compressed sensing (CS), enabling up to eightfold faster scans while maintaining image quality, resolution, and safety standards. These innovations now allow for 3- to 6-fold accelerated clinical musculoskeletal MRI exams, reducing scan times to 4 to 6min for joints and spine imaging. Evolving deep learning-based image reconstruction promises even faster scans without compromising quality. Current research indicates that combining acceleration techniques, deep learning image reconstruction, and superresolution algorithms will eventually facilitate tenfold accelerated musculoskeletal MRI in routine clinical practice. Such rapid MRI protocols can drastically reduce scan times by 80-90% compared to conventional methods. Implementing these rapid imaging protocols does impact workflow, indirect costs, and workload for MRI technologists and radiologists, which requires careful management. However, the shift from conventional to accelerated, deep learning-based MRI enhances the value of musculoskeletal MRI by improving patient access and comfort and promoting sustainable imaging practices. This article offers a comprehensive overview of the technical aspects, benefits, and challenges of modern accelerated musculoskeletal MRI, guiding radiologists and researchers in this evolving field.

MRI Safety Matters: Assessing the Knowledge of Radiologic Technologists and Nurses for Safe Imaging Practices

BackgroundConsiderable immediate safety risks are intrinsic to the magnetic resonance imaging (MRI) environment and must be acknowledged and prevented. PurposeThe purpose of this study was to analyze the impact of health professionals' characteristics on the mean knowledge in MRI safety domains and identify significant predictors for knowledge in these domains. Materials and MethodsA convenience sample of 433 participants was recruited from hospitals representing the four major health sectors in the country. The questionnaire consisted of questions about the demographics of the participants and their knowledge of the main domains of MRI safety. ResultsKnowledge of the main MRI safety domains and their associated subdomains varied among participants. MRI technologists, workers in private hospitals, and those who had courses/training had higher mean scores in all domains of MRI safety knowledge compared to their counterparts. ConclusionA statistically significant difference in the participants’ knowledge in the four main MRI safety domains based on participants’ characteristics.

Safety Survey on Lone Working Magnetic Resonance Imaging Technologists in Saudi Arabia

The American College of Radiology (ACR) requires MR personnel not to work alone due to the increased risk of safety issues such as projectiles, aggressive patients, and technologist fatigue. As a result, we intend to assess the current safety of lone-working MRI technologists in MRI departments in Saudi Arabia. A cross-sectional study using a self-report questionnaire was conducted in 88 Saudi hospitals. A response rate of 64% (174/270) was obtained among the 270 MRI technologists which were identified. The study discovered that 86% of MRI technologists had prior experience working alone. In terms of MRI safety training, 63% of MRI technologists received such training. A question about lone MRI workers' awareness of the ACR's recommendations revealed that 38% were unaware of such recommendations. Furthermore, 22% were misinformed, believing that working alone in an MRI unit is optional or depends on the individual's desire to work alone. Working alone has the primary consequence of being statistically significantly associated with projectile/object-related accidents/mistakes (p = 0.03). Saudi Arabian MRI technologists have extensive experience working alone without supervision. Most MRI technologists are unaware of lone working regulations, which has raised concerns about accidents/mistakes. There is a need for MRI safety training and adequate practical experience to raise awareness of MRI safety regulations and policies related to lone working among departments and MRI workers.

Quality of Work Life of Magnetic Resonance Imaging Technologists: A Cross-Sectional Study.

Quality of Work Life is a multi-dimensional discipline that is concerned with the quality of life in the workplace. This study aimed to assess quality of work-life level and identify the correlation between its dimensions and Job and Career Satisfaction. The study used the 32-item WRQoL-2 tool, a questionnaire consisting of 6 subscales: Job and Career Satisfaction, Control at Work, Home-Work Interface, General Wellbeing, Stress at Work, and Work Conditions, to assess for these correlations. 57 Magnetic Resonance Imaging Technologists (MRITs) (100%) responded to the questionnaire. The study found a high level of QWL among MRITs (66.2%, 3.31/5). The level of the JCS was high (71.6%, 3.59/5), with significant correlations between JCS and WCS, CAW, HWI, and GWB. An inverse relationship was noted between SAW and JCS. Further research on QWL is advised to diagnose and provide recommendation to resolve issues that may adversely affect the quality of healthcare service provision.

A narrative review of current and emerging MRI safety issues: What every MRI technologist (radiographer) needs to know.

Magnetic resonance imaging (MRI) has been traditionally regarded as a safe imaging modality due to the absence of ionising radiation. However, MRI is a source of potential hazards with a variety of risks including, but not limited to, those associated with the various electromagnetic fields used for imaging. All MRI technologists (radiographers) require sound knowledge of the physical principles of the MRI scanner and must understand the associated safety risks and how to avoid adverse events from occurring. MRI technologists now assume more responsibility in clinical decision‐making, and their knowledge base has consequently had to expand significantly. In addition, rapid advancements in MRI technology and other correlated areas such as medical implant technology, and the associated increase in MRI safety issues, place increasing demands on the MRI technologist to constantly keep abreast of current and future developments. This article reviews current and emerging MRI safety issues relevant to the three MRI electromagnetic fields and highlights the key information that all MRI technologists should be fully cognisant of to ensure competent and safe practice within the MRI environment.

Assessment of MRI technologists in acceptance and willingness to integrate artificial intelligence into practice

IntroductionThe integration of AI in medical imaging has tremendous exponential growth, especially in image production, image processing and image interpretation. It is expected that radiographers working across all imaging modalities have adequate knowledge as they are part of the end-user team. The current study aimed to investigate the knowledge, willingness and challenges facing the Magnetic Resonance Imaging (MRI) technologists in the integration of Artificial Intelligence (AI) into MRI practice. MethodsTotal of 120 participants were recruited using a snowball sampling technique. A two-phase study was undertaken using survey and focus group discussion (FGD) to capture participants' knowledge, interpretations, needs and obstacles toward AI integrations in MRI practice. The survey and FGD provided the base to understand the participant's’ knowledge, acceptance and needs for AI. ResultsResults showed medium to high knowledge, excitement about AI integration without disturbance of MRI practice. Participants thought that AI can improve MRI protocol selection (91.8%), reduce the scan time (65.3%), and improve image post-processing (79.5%). Education and learning resources concerning AI were the main obstacles facing MRI technologists. ConclusionMRI technologists have the knowledge and possess basic technical information. The application of AI in MRI practice might greatly influence and improve MRI technologist's work. A structured and professional program should be integrated in both undergraduate and continuous education to prepare for effective AI implementation. Implications for practiceApplication of AI in MRI can be used in many aspects, such as optimize image quality and avoidance of image artifacts. Moreover, AI can play an important role in patient's safety at the MRI unit to reduce incidents. Education, infrastructure, and knowledge of end-users are keys for the incorporation of AI use, development and optimisation.

Development of ACR quality control procedure for automatic assessment of spatial metrics in MRI

Quality control of Magnetic Resonance Imaging (MRI) equipment based on the American College of Radiology (ACR) protocol is a crucial tool for assuring the optimal functionality of the MRI scanner. This protocol includes the test of several parameters in particular spatial properties such as Slice position accuracy, high-contrast spatial resolution, and slice thickness accuracy. Those parameters are usually evaluated visually and manually using a workstation. As we know that Visual assessment is operator dependant and results may vary, so making the process automatic will reduce the errors and improve the accuracy. We propose in this study an automatic algorithm which is able to extract the three spatial proprieties. We tested our automated quality control process on ten MRI scanners. We assessed the performance of the proposed pipeline by comparing the measurements with the manual analysis made by three experienced MRI technologists. We also compared the results against the recommended values provided by the ACR quality assurance manual. Afterward, all data sets are quantitatively evaluated using the Pearson test by computing the correlation coefficient and the p-value. The comparison between our automatic quantitative algorithm and manual evaluation confirms the effectiveness of the proposed approaches. Accordingly, the results of the Pearson test showed that automated analysis correlated highly with manual analysis and the P-value was less than the significance level of 0.05. An interesting finding was that the total analysis time was significantly shorter than the time needed for manual analysis.

Automatic Analysis of ACR Phantom Images in MRI.

Quality Assurance (QA) of Magnetic Resonance Imaging (MRI) system is an essential step to avoid problems in diagnosis when image quality is low. It is considered a patient safety issue. The accreditation program of the American College of Radiology (ACR) includes a standardized image quality measurement protocol. However, it has been shown that human testing by visual inspection is not objective and not reproducible. The overall goal of the present paper was to develop and implement a fully automated method for accurate image analysis to increase its objectivity. It can positively impact the QA process by decreasing the reaction time, improving repeatability, and by reducing operator dependency. The proposed QA procedures were applied to ten clinical MRI scanners. The performance of the automated procedure was assessed by comparing the test results with the decisions made by trained MRI technologists according to ACR guidelines. The p-value, correlation coefficient of the manual and automatic measurements were also computed using the Pearson test. Compared to the manual process, the use of the proposed approach can significantly reduce the time requirements while maintaining consistency with manual measurements and furthermore, decrease the subjectivity of the results. Accordingly, a strong correlation was found and the corresponding p-value was much lower than the significance level of 0.05 indicating a good agreement between the two measurements.

Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions.

Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.

RECRUITING OLDER ADULTS WITH DEMENTIA FOR NEUROIMAGING RESEARCH: BARRIERS AND SOLUTIONS

Recruiting participants with dementia for magnetic resonance imaging (MRI) research is prone to inherent barriers including caregiver schedules, mistrust, transportation, expertise of MRI technologists, claustrophobia, and MRI safety requirements. This pilot study aimed to identify barriers and develop strategies for increasing recruitment and retention of persons with dementia in neuroimaging studies and to gauge improvements in recruitment outcomes associated with dedicated recruitment staff. Over a period of five years of active recruitment, a dedicated recruitment specialist and a full-time research assistant screened and enrolled an average of eight participants with dementia per month (8.16), of which, approximately two participants (1.97) successfully completed the MRI testing. The most common barrier was difficulty obtaining surgical records for MRI safety clearance. The most common solutions were thorough prescreening and maintaining a positive rapport with MRI technologists. Our study findings will assist others with engaging persons with dementia and their caregivers in MRI research.

Impact on child and parent anxiety level of a teddy bear-scale mock magnetic resonance scanner.

Pediatric magnetic resonance imaging (MRI) can be stressful. Mock MR scanners have been proven to be effective in avoiding the use of general anesthesia. We prospectively evaluated the impact of a teddy bear-scale model of a mock MR scanner on the anxiety experienced by parents and their children during MRI without general anesthesia . A 1-year prospective study before and after the installation of a mock scanner in a Pediatric Radiology Department of a university hospital. Anxiety levels were self-estimated by children ages 4 to 16years and by the parents with a visual analogue scale (from 0, completely relaxed, to 100, extremely stressed) at three moments: in the waiting room, in the preparation room after an explanation by the MRI technologists, and at the issue of the MR acquisition images. Two groups were tested: one with a mock MR scanner, the other without. Analysis of variance (ANOVA) and Fisher exact tests were performed. Motion artifacts were studied. Ninety-one children and their parents were included. The median age was 8years (standard deviation [SD]=2). In the post mock period, the ambiance of the preparation room was considered by children as significantly more relaxing in 50% vs. 20% (P=0.004) and the anxiety level of children was significantly lower after the explanation, particularly in girls, but unchanged for their parents. The anxiety levels at the end of the examination were significantly lower for parents. The motion artifacts rate was lower (1.7% vs. 4.7%, P=0.04). A mock scanner was an efficient tool to improve efficiency of the explanation and to decrease anxiety in children and motion artifacts in pediatric MRI.

The Use of Proton MR Spectroscopy in Epilepsy: A Methodological Review

Magnetic Resonance Spectroscopy (MRS) has at least two major roles in the evaluation of epileptic patients. First, MRS can help to understand the interaction between seizures and metabolic function. Thus, MRS is particularly interesting for basic science studies of seizures and epilepsy. Second, MRS can explain the nature of seizure control and/or provide localization information by measuring metabolic changes. So MRS can be used as a powerful complementary technique to structural MRI for diagnosis and assessment of response to therapy, and measurement of disease progression. The aim of this paper is to review the methodological aspects of 1H-MRS publications between 1994 to 2016, which utilized 1H-MRS in lateralizing the epileptogenic zone in lesional and non-lesional Temporal Lobe Epilepsy (TLE), Extra-Temporal Lobe Epilepsy (ETLE), and generalized epileptic patients to help the spectroscopist, magnetic resonance imaging technologists, and radiologists to improve the overall diagnostic sensitivity in epileptic patients.

Foot Massage, Touch, and Presence in Decreasing Anxiety during a Magnetic Resonance Imaging: A Feasibility Study.

The purpose of the study was to determine (1) recruitment feasibility; (2) intervention adherence; (3) intervention acceptability; and (4) the preliminary effects of touch or foot massage interventions on anxiety during a magnetic resonance imaging (MRI). A quasi-experimental design was used. Foot massage and touch were the intervention groups and "presence" was the control group. The study was conducted at the Center for Neurosciences, a freestanding facility, in southern Arizona. The sample (N = 60) was predominantly Caucasian (58.3%), married (55%), and college educated (43.3%). There were 39 females and 21 males. Fifty-three percent of the participants had an MRI head scan. Recruitment feasibility was the percentage of participants enrolled out of those screened. Adherence to foot massage and touch interventions was measured by the researcher's ability to apply full intervention for 20 min. Four factors measured participants' acceptance of the interventions as follows: (1) comfort; (2) acceptability of the length of the treatment; (3) perception of effectiveness; and (4) recommendation of treatment as part of routine MRI care. The MRI technologists' acceptability was measured by whether the intervention: (1) disrupted the workflow and (2) affected the length of the scan. State anxiety was assessed verbally by a single 10-point Likert type item. Recruitment feasibility was 78.2%. There were no barriers to the intervention protocol for 91.6% participants. The overall mean value of perceived effectiveness was 8.53, SD = 2.4 on a 10-point Likert type question. There was a significant difference among the three groups in terms of perceived effectiveness of the intervention F(2, 57) = 15.19, p < 0.001. Multilevel modeling documented that the foot massage intervention was a significant predictor of decreasing anxiety (β = -1.35, SE = 0.63, p < 0.01). The use of foot massage or touch is feasible, acceptable by patients and technologists, and the use of foot massage was associated with lower state anxiety.

Diagnostic Value of MRI in Patients With Implanted Pacemakers and Implantable Cardioverter-Defibrillators Across a Cross Population: Does the Benefit Justify the Risk? A Proof of ConceptStudy.

The objective of this study was to assess the diagnostic usefulness of thoracic and nonthoracic magnetic resonance imaging (MRI) imaging in patients with implantable cardiac devices (permanent pacemaker or implantable cardioverter-defibrillators [ICDs]) to determine if there was a substantial benefit to patients with regard to diagnosis and/or management. MRI is infrequently performed on patients with conventional pacemakers or ICDs. Multiple studies have documented the safety of MRI scansin patients with implanted devices, yet the diagnostic value of this approach has not been established. Evaluation data were acquired in 136 patients with implanted cardiac devices who underwent MRIs during a 10-year period at a single institution. Specific criteria were followed for all patients to objectively define if the diagnosisby MRI enhanced patient care; 4 questions were answered after scan interpretation by both MRI technologists and MRI physicians who performed the scan. 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If "Yes" was answered to any of the preceding questions, the MRI scan was considered to be of value to patient diagnosis and/or therapy. In 97% (n= 132) of patients, MR added value to patient diagnosis and management. In 49% (n= 67) of patients, MRI added additional valuable information to the primary diagnosis, and in 30% (n= 41) of patients, MRI changed the principle diagnosis and subsequent management of the patient. No safety issues were encountered, and no adverse effects of undergoing the MRI scan were noted in any patient. MRI in patients with implanted pacemakers and defibrillators added value to patient diagnosis andmanagement, which justified the risk of the procedure.

Bone marrow fat content is correlated with hepatic fat content in paediatric non-alcoholic fatty liver disease

To investigate the relationship between bone marrow fat content and hepatic fat content in children with known or suspected non-alcoholic fatty liver disease (NAFLD). This was an institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant, cross-sectional, prospective analysis of data collected between October 2010 to March 2013 in 125 children with known or suspected NAFLD. Written informed consent was obtained for same-day research magnetic resonance imaging (MRI) of the lumbar spine, liver, and abdominal adiposity. Lumbar spine bone marrow proton density fat fraction (PDFF) and hepatic PDFF were estimated using complex-based MRI (C-MRI) techniques and magnitude-based MRI (M-MRI), respectively. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SCAT) were quantified using high-resolution MRI. All images were acquired by two MRI technologists. Hepatic M-MRI images were analysed by an image analyst; all other images were analysed by a single investigator. The relationship between lumbar spine bone marrow PDFF and hepatic PDFF was assessed with and without adjusting for the presence of covariates using correlation and regression analysis. Lumbar spine bone marrow PDFF was positively associated with hepatic PDFF in children with known or suspected NAFLD prior to adjusting for covariates (r=0.33, p=0.0002). Lumbar spine bone marrow PDFF was positively associated with hepatic PDFF in children with known or suspected NAFLD (r=0.24, p=0.0079) after adjusting for age, sex, body mass index z-score, VAT, and SCAT in a multivariable regression analysis. Bone marrow fat content is positively associated with hepatic fat content in children with known or suspected NAFLD. Further research is needed to confirm these results and understand their clinical and biological implications.

Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands.

BackgroundResponse-guided neoadjuvant chemotherapy (RG-NACT) with magnetic resonance imaging (MRI) is effective in treating oestrogen receptor positive/human epidermal growth factor receptor-2 negative (ER-positive/HER2-negative) breast cancer. We estimated the expected cost-effectiveness and resources required for its implementation compared to conventional-NACT.MethodsA Markov model compared costs, quality-adjusted-life-years (QALYs) and costs/QALY of RG-NACT vs. conventional-NACT, from a hospital perspective over a 5-year time horizon. Health services required for and health outcomes of implementation were estimated via resource modelling analysis, considering a current (4 %) and a full (100 %) implementation scenario.ResultsRG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94 % (current) and 95 % (full) certainty, at a willingness to pay threshold of €20.000/QALY. Fully implementing RG-NACT in the Dutch target population of 6306 patients requires additional 5335 MRI examinations and an (absolute) increase in the number of MRI technologists, by 3.6 fte (full-time equivalent), and of breast radiologists, by 0.4 fte. On the other hand, it prevents 9 additional relapses, 143 cancer deaths, 23 congestive heart failure events and 2 myelodysplastic syndrome/acute myeloid leukaemia events.ConclusionConsidering cost-effectiveness, RG-NACT is expected to dominate conventional-NACT. While personnel capacity is likely to be sufficient for a full implementation scenario, MRI utilization needs to be intensified.

On replacing the manual measurement of ACR phantom images performed by MRI technologists with an automated measurement approach.

To assess whether measurements on American College of Radiology (ACR) phantom images performed by magnetic resonance imaging (MRI) technologists as part of a weekly quality control (QC) program could be performed exclusively using an automated system without compromising the integrity of the QC program. ACR phantom images are acquired on 15 MRI scanners at a number of ACR-accredited sites to fulfill requirements of a weekly QC program. MRI technologists routinely perform several measurements on these images. Software routines are also used to perform the measurements. A set of geometry measurements made by technologists over a five week period and those made using software routines were compared to reference-standard measurements made by two MRI physicists. The geometry measurements performed by software routines had a very high positive correlation (0.92) with the reference-standard measurements. Technologist measurements also had a high positive correlation (0.63), although the correlation was less than for the automated measurements. Bland-Altman analysis revealed overall good agreement between the automated and reference-standard measurements, with the 95% limits of agreement being within ±0.62 mm. Agreement between the technologist and the reference-standard measurements was demonstratively poorer, with 95% limits of agreement being ±1.46 mm. Some of the technologist measurements differed from the reference standard by as much as 2 mm. The technologists' geometry measurements may be able to be replaced by automated measurement without compromising the weekly QC program required by the ACR.

TH-AB-207-00: MR Safety

TH-AB-207-00: MR Safety

TH-AB-207-02: Active Implants in MRI: The MRI Industry's Perspective

TH-AB-207-02: Active Implants in MRI: The MRI Industry's Perspective

TH-AB-207-04: Active Implants in MRI: The MR Technologist's Perspective

TH-AB-207-04: Active Implants in MRI: The MR Technologist's Perspective