MRI and cancer diagnosis

Jan 5, 2006

MRI utilization has been climbing at double-digit rates for decades. This is due largely to the modality's financial success, which has spread the deployment of MRI providers far and wide -- making MRI one of the most accessible imaging modalities available.

Growth has also come from new clinical applications that, when coupled with the financial rewards of MRI, have fueled an ongoing turf battle as radiologists defend their specialization from cardiologists who have adopted CT and now MR for their patients. But perhaps the biggest news to hit MRI, from both financial and clinical perspectives, will be the burgeoning use of MR in oncology.

The demographics of the U.S. point to increasing needs for oncology diagnosis and treatment in the decades ahead as the population of baby boomers ages. This increasing demand is fueling development of new diagnostic tools and treatment pathways, both in terms of medications and medical devices. A bellwether of this new development may well be breast cancer.

October was Breast Cancer Awareness Month and it would have been impossible to open a radiology trade magazine or journal without finding features on MRI's growing role in breast cancer diagnosis. From superior imaging of dense breast tissue to the detection of smaller masses than conventional mammography to the growth in MR-guided needle biopsies, MRI is seeing significant growth in breast cancer detection.

But beyond the conventional, the journal Radiology published a study about the tremendous success that MR spectroscopy has demonstrated in differentiating cancerous breast tumors from benign ones. The efficacy of spectroscopy currently depends on higher field-strength magnets (typically 3 tesla and above) and specialized applications, but it may not be long before versions of the technology are available for properly configured 1.5-tesla suites (August 2005, Vol. 236:8, pp. 465-475).

One obstacle to the greater utilization of MRI in breast screening and diagnosis is cost. Breast exams can be protracted, particularly spectrographic analysis, and reimbursement for breast exams doesn't compete with other exams, creating a financial disincentive for providers when other scans are possible. If an MR-based version of a mammography machine were developed, it might simultaneously accelerate throughput and reduce equipment and operational costs. This has been the specific mission of Specialty Scanners of Surrey, U.K.

In September 2005, Specialty Scanners announced the successful prototype of its dedicated breast scanner, developed in collaboration with the Institute of Cancer Research, the Council for the Central Laboratory of the Research Councils, and with the support of the U.K. Department of Health and the Engineering and the Physical Sciences Research Council. The scanner has also been reportedly designed to integrate with future image-guided biopsy and ablation technologies, enabling it to serve both diagnostic and treatment functions.

As might be expected, Specialty Scanners is keeping especially tight-lipped about the format of their MRI device, and may seek to monopolize the application, at least in the U.K., by operating its scanners in wholly owned or directly controlled outpatient facilities. But should the technology prove to be effective in both the clinical and financial realms, either Specialty Scanner's product, or another vendor's iteration of a dedicated breast MR device, will surely find its way to global distribution.

While Specially Scanners did not unveil its product at the 2005 RSNA meeting in Chicago, many of the MRI vendors as well as specialty coil manufacturers did show off new wares for breast screening and intervention, including the dedicated 1.5-tesla breast MRI system by Aurora Imaging Technology (North Andover, MA).

And breast cancer is only the beginning. As MR spectroscopy is refined to identify the chemical flags for other cancers in other parts of the anatomy, and as MR imaging resolution grows, MRI becomes a superior platform not only for noninvasive diagnosis, but also in treatment planning, simulation, and monitoring.

Facilities looking to prepare for oncology diagnosis in their MRI suites should consider the following:

Your planned next magnet may not be the ideal platform for the new diagnostic or interventional applications. Plan for subsequent equipment upgrades and replacements.
Spectrographic studies require more than high-field magnets; they need a facility with extremely low ferrous interference. MRI suites should be very carefully sited, designed, and constructed to maximize clinical value.
Look beyond vendor templates. New clinical applications often require additional hardware. Building a room to the bare minimums won't give you any flexibility to accept new equipment.

By Robert Junk and Tobias Gilk
AuntMinnie.com contributing writers
January 6, 2006

Reprinted from www.mri-planning.com by permission of the authors. If you would like more information on any aspect of MR facility design or safety, please contact Robert Junk or Tobias Gilk at Jünk Architects.

MRI vendor suite templates: What they don't show, December 8, 2005

Hitting the ceiling over HIPAA-required walls, December 6, 2005

Burying MRI construction mistakes: What you cannot see affects what you can, November 23, 2005

The new 'MR Safe': Language changes for the FDA, October 27, 2005