Optimization of MRI Turnaround Times Through the Use of Dockable Tables and Innovative Architectural Design Strategies

Clinical Implementation of Sixfold-Accelerated Deep Learning Super-Resolution Knee MRI in Under 5 Minutes: Arthroscopy-Validated Diagnostic Performance

Background - Deep learning (DL) super-resolution image reconstruction enables higher acceleration factors for combined parallel imaging-simultaneous multislice-accelerated knee MRI but requires performance validation against external reference standards. Objective - The purpose of this study was to validate the clinical efficacy of sixfold-accelerated sub-5-minute 3-T knee MRI employing combined threefold parallel imaging (PI)-twofold simultaneous multislice (SMS) acceleration and DL super-resolution image reconstruction against arthroscopic surgery. Methods - Consecutive adult patients with painful knee conditions who underwent sixfold PI-SMS-accelerated DL super-resolution 3-T knee MRI and arthroscopic surgery between October 2022 and July 2023 were retrospectively included. Seven fellowship-trained musculoskeletal radiologists independently assessed the MRI studies for image quality parameters, presence of artifacts, structural visibility (Likert scales: 1 [very bad/severe] to 5 [very good/absent]), and the presence of cruciate ligament tears, collateral ligament tears, meniscal tears, cartilage defects, and fractures. Statistical analyses included kappa-based interreader agreements and diagnostic performance testing. Results - The final sample included 124 adult patients (mean age ± SD, 46 ± 17 years; 79 men, 45 women) who underwent knee MRI and arthroscopic surgery within a median of 28 days (range, 4-56 days). Overall image quality was good to very good (median, 4 [IQR, 4-5]) with very good interreader agreement (κ = 0.86). Motion artifacts were absent (median, 5 [IQR, 5-5]), and image noise was minimal (median, 4 [IQR, 4-5]). Visibility of anatomic structures was very good (median, 5 [IQR, 5-5]). Diagnostic performance for diagnosing arthroscopy-validated structural abnormalities was good to excellent (AUC ≥ 0.81) with at least good interreader agreement (κ ≥ 0.72). The sensitivity, specificity, accuracy, and AUC values were 100%, 99%, 99%, and 0.99, for anterior cruciate ligament tears; 100%, 100%, 100%, and 1.00 for posterior cruciate ligament tears; 90%, 95%, 94%, and 0.93 for medial meniscus tears; 76%, 97%, 90%, and 0.86 for lateral meniscus tears; and 85%, 88%, 88%, and 0.81 for articular cartilage defects, respectively. Conclusion - Sixfold PI-SMS-accelerated sub-5-minute DL super-resolution 3-T knee MRI has excellent diagnostic performance for detecting internal derangement. Clinical Impact - Sixfold PI-SMS-accelerated DL super-resolution 3-T knee MRI provides high efficiency through short scan times and high diagnostic performance.

Impact of optimized and conventional facility designs on outpatient abdominal MRI workflow efficiency

PURPOSE

The goal of this study was to evaluate the outpatient workflow efficiency of an optimized facility (OF) compared to an established reference facility (RF) for abdominal magnetic resonance imaging (MRI).

METHODS

In this retrospective study, we analyzed 2,723 contrast-enhanced liver and prostate MRI examinations conducted between March 2022 and April 2024. All examinations were performed on 3T scanners (MAGNETOM Vida, Siemens Healthineers) at two different imaging facilities within our institution. The optimized facility featured a three-bay setup, with each bay consisting of one magnet, two dockable tables, and one dedicated preparation room, while the reference facility utilized a single scanner-single table setup with one dedicated preparation room. Workflow metrics were extracted from scanner logs and electronic health records. Three-way ANOVA and chi-square tests were used to assess the impact of facility design, body region, and date on workflow metrics.

RESULTS

The OF significantly reduced mean table turnaround times (4.6 min vs. 8.3 min, p < 0.001) and achieved shorter total process cycle times for both liver (30.6 min vs. 32.7 min, p < 0.01) and prostate exams (32.5 min vs. 36.4 min, p < 0.001) compared to the RF. Additionally, the OF achieved turnaround times of ≤ 1 min in 37.2% of exams, compared to just 0.6% at the RF (p < 0.001). On-time performance was also notably higher at the OF (79.4% vs. 66.0%, p < 0.001). Furthermore, the mean time from patient arrival to exam start was reduced by 9 min at the OF (p < 0.001). Minor differences in acquisition times were observed between facilities, with both benefiting from deep learning reconstruction techniques.

CONCLUSION

The optimized MRI facility demonstrated superior outpatient workflow efficiency compared to an already efficient reference facility, particularly in table turnover time, resulting in increased patient throughput for abdominal MRI examinations. These findings highlight that even highly efficient MRI facilities can significantly benefit from comprehensive redesign strategies.

Arthroscopy-validated Diagnostic Performance of 7-Minute Five-Sequence Deep Learning Super-Resolution 3-T Shoulder MRI

Background Deep learning (DL) methods enable faster shoulder MRI than conventional methods, but arthroscopy-validated evidence of good diagnostic performance is scarce. Purpose To validate the clinical efficacy of 7-minute threefold parallel imaging (PIx3)-accelerated DL super-resolution shoulder MRI against arthroscopic findings. Materials and Methods Adults with painful shoulder conditions who underwent PIx3-accelerated DL super-resolution 3-T shoulder MRI and arthroscopy between March and November 2023 were included in this retrospective study. Seven radiologists independently evaluated the MRI scan quality parameters and the presence of artifacts (Likert scale rating ranging from 1 [very bad/severe] to 5 [very good/absent]) as well as the presence of rotator cuff tears, superior and anteroinferior labral tears, biceps tendon tears, cartilage defects, Hill-Sachs lesions, Bankart fractures, and subacromial-subdeltoid bursitis. Interreader agreement based on κ values was evaluated, and diagnostic performance testing was conducted. Results A total of 121 adults (mean age, 55 years ± 14 [SD]; 75 male) who underwent MRI and arthroscopy within a median of 39 days (range, 1-90 days) were evaluated. The overall image quality was good (median rating, 4 [IQR, 4-4]), with high reader agreement (κ ≥ 0.86). Motion artifacts and image noise were minimal (rating of 4 [IQR, 4-4] for each), and reconstruction artifacts were absent (rating of 5 [IQR, 5-5]). Arthroscopy-validated abnormalities were detected with good or better interreader agreement (κ ≥ 0.68). The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were 89%, 90%, 89%, and 0.89, respectively, for supraspinatus-infraspinatus tendon tears; 82%, 63%, 68%, and 0.68 for subscapularis tendon tears; 93%, 73%, 86%, and 0.83 for superior labral tears; 100%, 100%, 100%, and 1.00 for anteroinferior labral tears; 68%, 90%, 82%, and 0.80 for biceps tendon tears; 42%, 93%, 81%, and 0.64 for cartilage defects; 93%, 99%, 98%, and 0.94 for Hill-Sachs deformities; 100%, 99%, 99%, and 1.00 for osseous Bankart lesions; and 97%, 63%, 92%, and 0.80 for subacromial-subdeltoid bursitis. Conclusion Seven-minute PIx3-accelerated DL super-resolution 3-T shoulder MRI has good diagnostic performance for diagnosing tendinous, labral, and osteocartilaginous abnormalities. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Tuite in this issue.

Flexible and wireless metasurface coils for knee and elbow MRI

BACKGROUND

Metasurface coils (MCs) are a promising magnetic resonance imaging (MRI) technology. Aiming to evaluate the image quality of MCs for knee and elbow imaging, we compared signal-to-noise ratio (SNRs) obtained in standard clinical setups.

METHODS

Knee and elbow MRI routine sequences were applied at 1.5 T, implementing four coil scenarios: (1) 15-channel transmit/receive knee coil; (2) four-channel multipurpose coil (flex coil); (3) MC + spine coil; and (4) MC + multipurpose coil. Three regions of interest (ROIs) at different anatomical depths were compared.

RESULTS

Seven participants (aged 28 ± 2 years; 6 males) were enrolled. In elbow MRI, the MC + spine coil demonstrated the highest SNR across all ROIs (superficial-anterior: +114%, p = 0.008; middle: +147%, p = 0.008; deep-posterior: +24%, p = 0.039) compared to the flex coil and all ROIs, except the deepest from the MC, compared to the knee coil (superficial-anterior: +28%, p = 0.016; middle: +104%, p = 0.008; deep-posterior: -1%, p = 0.531). In knee MRI, the MC + spine coil provided higher SNR compared to the flex coil, except posterior (superficial-anterior: +69%, p = 0.008; middle: +288%, p = 0.008; deep-posterior: -12%, p = 0.148) versus the knee coil, the MC + spine coil was superior in the middle but non-different in superficial pre-patellar areas and less in deep-posterior areas (superficial-anterior: -8%, p = 0.188; middle: +44%, p = 0.008; deep-posterior: -36%, p = 0.016).

CONCLUSION

Wireless MCs exhibited great potential for knee and elbow MRI outperforming the flex coil. Future developments will improve the posterior illumination to increase its clinical value.

RELEVANCE STATEMENT

MCs offer enhanced versatility, flexibility, and patient comfort. If universal MC designs can achieve image quality comparable to those of standard coils and simultaneously be utilized across multiple body areas, the technology may revolutionize future musculoskeletal MRIs.

KEY POINTS

MCs are promising in MRI, but homogeneity is challenging depending on the design. Signal-to-noise-ratio was improved for knee and elbow imaging with slight inhomogeneous illumination. MCs could match the image quality of standard coils in both knee and elbow imaging.

Extremely dense breasts: A comprehensive review of increased cancer risk and supplementary screening methods

Women with extremely dense breasts account for approximately 10% of the screening population and face an increased lifetime risk of developing breast cancer. At the same time, the sensitivity of mammography, the first-line screening modality, is significantly reduced in this breast density group, owing to the masking effect of the abundant fibroglandular tissue. Consequently, this population has garnered increasing scientific attention due to the unique diagnostic challenge they present. Several research initiatives have attempted to address this diagnostic challenge by incorporating supplemental imaging modalities such as ultrasound, MRI, and contrast-enhanced mammography. Each of these modalities offers different benefits as well as limitations, both clinically and practically, including considerations of availability and costs. The purpose of this article is to critically review the background, latest scientific evidence, and future directions for the use of the various supplemental screening techniques for women with extremely dense breasts.

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 6 min 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.

Designing Clinical MRI for Enhanced Workflow and Value

MRI is an expensive and traditionally time-intensive modality in imaging. With the paradigm shift toward value-based healthcare, radiology departments must examine the entire MRI process cycle to identify opportunities to optimize efficiency and enhance value for patients. Digital tools such as "frictionless scheduling" prioritize patient preference and convenience, thereby delivering patient-centered care. Recent advances in conventional and deep learning-based accelerated image reconstruction methods have reduced image acquisition time to such a degree that so-called nongradient time now constitutes a major percentage of total room time. For this reason, architectural design strategies that reconfigure patient preparation processes and decrease the turnaround time between scans can substantially impact overall throughput while also improving patient comfort and privacy. Real-time informatics tools that provide an enterprise-wide overview of MRI workflow and Picture Archiving and Communication System (PACS)-integrated instant messaging can complement these efforts by offering transparent, situational data and facilitating communication between radiology team members. Finally, long-term investment in training, recruiting, and retaining a highly skilled technologist workforce is essential for building a pipeline and team of technologists committed to excellence. Here, we highlight various opportunities for optimizing MRI workflow and enhancing value by offering many of our own on-the-ground experiences and conclude by anticipating some of the future directions for process improvement and innovation in clinical MR imaging. EVIDENCE LEVEL: N/A TECHNICAL EFFICACY: Stage 1.

Optimized, Person-Centered Workflow Design for a High-Throughput Breast MRI Screening Facility-A Simulation Study

OBJECTIVES

This project aims to model an optimal scanning environment for breast magnetic resonance imaging (MRI) screening based on real-life data to identify to what extent the logistics of breast MRI can be optimized.

MATERIALS AND METHODS

A novel concept for a breast MRI screening facility was developed considering layout of the building, workflow steps, used resources, and MRI protocols. The envisioned screening facility is person centered and aims for an efficient workflow-oriented design. Real-life data, collected from existing breast MRI screening workflows, during 62 scans in 3 different hospitals, were imported into a 3D simulation software for designing and testing new concepts. The model provided several realistic, virtual, logistical pathways for MRI screening and their outcome measures: throughput, waiting times, and other relevant variables.

RESULTS

The total average appointment time in the baseline scenario was 25:54 minutes, with 19:06 minutes of MRI room occupation. Simulated improvements consisted of optimizing processes and resources, facility layout, and scanning protocol. In the simulation, time spent in the MRI room was reduced by introducing an optimized facility layout, dockable tables, and adoption of an abbreviated MRI scanning protocol. The total average appointment time was reduced to 19:36 minutes, and in this scenario, the MRI room was occupied for 06:21 minutes. In the most promising scenario, screening of about 68 people per day (10 hours) on a single MRI scanner could be feasible, compared with 36 people per day in the baseline scenario.

CONCLUSIONS

This study suggests that by optimizing workflow MRI for breast screening total appointment duration and MRI occupation can be reduced. A throughput of up to 6 people per hour may be achieved, compared with 3 people per hour in the current setup.

Predicting slot lengths of MRI exams to decrease observed discrepancies between planning and execution

This retrospective study aimed to reveal discrepancies between planned (Tplan) and actual (Tact) slot lengths of abdomen MRI exams, and to improve Tplan by predicting slot lengths via a machine learning algorithm. Tplan and Tact were retrieved from RIS and modality logfiles, respectively, covering 3038 MRI exams of 17 protocols performed at an abdomen department. Comparisons showed that 30% of exams exceeded planned slot lengths. On the other hand, exams completed within planning failed to manifest good adherence to schedule, as many of them were assigned with an unnecessarily long slot. While adjusting the planned exam duration by a fixed amount of time for each protocol could move Tplan closer to the mean or median Tact, the large spread of Tact would still be unaffected. This is why this study goes one step further, introducing a method to predict the required slot length not only per protocol, but for each individual exam. A Random Forest Regression model was trained on historic data to predict individual slot lengths (Tpred) based on patient and exam context. The correlation between Tpred and Tact was found to be better than that of Tplan and Tact, with Pearson correlation factors of 0.66 and 0.50, respectively. The overall adherence to schedule was also improved by the prediction, as seen by a reduction of both the root mean squared error (-28%) and the standard deviation (-16%) of the differences between planned/predicted slot times and Tact. To provide further insights into the discrepancies between planning and execution of MRI exams, nineteen exams from the Liver protocol with verified clinical information were selected. This case study showed that patient conditions, diagnostic purposes and the selection of sequences during exams could explain some variations of exam durations, but the potential for improving the exam time prediction by including this additional context is limited.

Five-minute knee MRI: An AI-based super resolution reconstruction approach for compressed sensing. A validation study on healthy volunteers

PURPOSE

To investigate the potential of combining Compressed Sensing (CS) and a newly developed AI-based super resolution reconstruction prototype consisting of a series of convolutional neural networks (CNN) for a complete five-minute 2D knee MRI protocol.

METHODS

In this prospective study, 20 volunteers were examined using a 3T-MRI-scanner (Ingenia Elition X, Philips). Similar to clinical practice, the protocol consists of a fat-saturated 2D-proton-density-sequence in coronal, sagittal and transversal orientation as well as a sagittal T1-weighted sequence. The sequences were acquired with two different resolutions (standard and low resolution) and the raw data reconstructed with two different reconstruction algorithms: a conventional Compressed SENSE (CS) and a new CNN-based algorithm for denoising and subsequently to interpolate and therewith increase the sharpness of the image (CS-SuperRes). Subjective image quality was evaluated by two blinded radiologists reviewing 8 criteria on a 5-point Likert scale and signal-to-noise ratio calculated as an objective parameter.

RESULTS

The protocol reconstructed with CS-SuperRes received higher ratings than the time-equivalent CS reconstructions, statistically significant especially for low resolution acquisitions (e.g., overall image impression: 4.3 ± 0.4 vs. 3.4 ± 0.4, p < 0.05). CS-SuperRes reconstructions for the low resolution acquisition were comparable to traditional CS reconstructions with standard resolution for all parameters, achieving a scan time reduction from 11:01 min to 4:46 min (57 %) for the complete protocol (e.g. overall image impression: 4.3 ± 0.4 vs. 4.0 ± 0.5, p < 0.05).

CONCLUSION

The newly-developed AI-based reconstruction algorithm CS-SuperRes allows to reduce scan time by 57% while maintaining unchanged image quality compared to the conventional CS reconstruction.

The patients' experience of neuroimaging of primary brain tumors: a cross-sectional survey study

PURPOSE

To gain insight into how patients with primary brain tumors experience MRI, follow-up protocols, and gadolinium-based contrast agent (GBCA) use.

METHODS

Primary brain tumor patients answered a survey after their MRI exam. Questions were analyzed to determine trends in patients' experience regarding the scan itself, follow-up frequency, and the use of GBCAs. Subgroup analysis was performed on sex, lesion grade, age, and the number of scans. Subgroup comparison was made using the Pearson chi-square test and the Mann-Whitney U-test for categorical and ordinal questions, respectively.

RESULTS

Of the 100 patients, 93 had a histopathologically confirmed diagnosis, and seven were considered to have a slow-growing low-grade tumor after multidisciplinary assessment and follow-up. 61/100 patients were male, with a mean age ± standard deviation of 44 ± 14 years and 46 ± 13 years for the females. Fifty-nine patients had low-grade tumors. Patients consistently underestimated the number of their previous scans. 92% of primary brain tumor patients did not experience the MRI as bothering and 78% would not change the number of follow-up MRIs. 63% of the patients would prefer GBCA-free MRI scans if diagnostically equally accurate. Women found the MRI and receiving intravenous cannulas significantly more uncomfortable than men (p = 0.003). Age, diagnosis, and the number of previous scans had no relevant impact on the patient experience.

CONCLUSION

Patients with primary brain tumors experienced current neuro-oncological MRI practice as positive. Especially women would, however, prefer GBCA-free imaging if diagnostically equally accurate. Patient knowledge of GBCAs was limited, indicating improvable patient information.

Factors affecting MRI scanner efficiency in an academic center

PURPOSE

To determine which patient characteristics influence MRI scan time and how.

METHODS

A database search of outpatient MRI liver examinations on 1.5T and 3T scanners from 1/1/2019 to 4/4/2019 was performed using an in-house developed software tool. Mean and median scan times were calculated. Patients who had difficulty following breathing instructions or completing breath-hold sequences were identified. Twenty-one additional patient characteristics were obtained from an Electronic Medical Record (EMR) search.

RESULTS

Scan times were significantly increased for patients with breath-holding issues during the exam (N = 43, median = 23.98 min) versus not (N = 179, median = 17.5 min, p < 0.001). Among patients who had difficulty following breathing instructions/completing breath-hold sequences, a significant number were non-native English speakers (23/43, 53%) compared to those whose first language was English (48/179, 27%, p < 0.001). Breath-holding issues were also significantly more frequent for patients requiring a translator during the exam (15/43, 35%) versus those who did not (24/179, 13%, p < 0.001). No other patient characteristics showed a significance difference between those with breathing issues and those without. Patient characteristics that caused a significant number of scan times to be one standard deviation or more above the median were as follows: Breath-holding issues during exam (21/43 ≥ one SD above, 51%, versus 22/189 < one SD above, 12%, p < 0.001); and first language not English (16/71 ≥ one SD above, 23%, versus 55/189 < one SD above, 29%, p = 0.03).

CONCLUSION

The ability to follow breathing instructions and complete breath-hold sequences had a significant impact on patient scan time. Patients who were not native English speakers had more frequent breathing issues during scans and significantly longer scans times compared native English speakers.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean–Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.

Software-Based Evaluation of Optimization Potential for Clinical MRI Scanners in Radiology

OBJECTIVE

 The aim of the study was to use a software application to analyze the examination times and changeover times of two clinically highly applied MRI scanners at a university hospital for radiology and to evaluate whether this could result in optimization potential for examination planning in the daily clinical routine of MRI diagnostics.

MATERIALS AND METHODS

 Based on the newly developed software application "Teamplay Usage" (Siemens Healthineers, Germany), the examinations carried out on two MRI scanners (1.5 T and 3 T) were investigated within an analysis period of 12 months with regard to the type of examination and its duration. In addition, compliance with the previously defined planning time (30, 45, 60 min.) was checked and deviations were analyzed. In addition, the changeover times between the examinations were determined and a possible influence due to the exchange of MRI coils was investigated for a selection of change combinations.

RESULTS

 For the total of 7184 (1.5 T: 3740; 3 T: 3444) examinations included in the study, the median examination time was 43:02 minutes (1.5 T: 43:17 min.; 3 T: 42:45 min.). The ten most frequent types of examinations per MRI scanner were completed within the predefined plan time of 54.5 % (1.5 T) and 51.9 % (3 T), taking into account a previously defined preparation and post-processing time of 9 minutes per examination. Overall, more time was spent on examinations with a planned time of 30 minutes, whereas the majority of the examinations planned with 45 minutes were also completed within this time. Examinations with a planned time of 60 minutes usually took less time. A comparison between the planned time and the determined examination duration of the most common types of examinations showed overall a slight potential for optimization. Coil exchanges between two examinations had a small, but statistically not significant effect on the median changeover time (p = 0.062).

CONCLUSION

 Utilizing a software-based analysis, a detailed overview of the type of examination, examination duration, and changeover times of frequently used clinical MRI scanners could be obtained. In the clinic examined, there was little potential for optimization of examination planning. An exchange of MRI coils necessary for different types of examination only had a small effect on the changeover times.

KEY POINTS

  · The use of the "Teamplay Usage" software application enables a comprehensive overview of the type of examination, examination duration, and changeover times for MRI scanners.. · Adjustments to examination planning for MRI diagnostics show optimization potential, which, however, is to be assessed as low in the clinic examined.. · Necessary replacements of MRI coils only have a small effect on the changeover times..

CITATION FORMAT

· Meyl TP, Berghöfer A, Blatter T et al. Software-Based Evaluation of Optimization Potential for Clinical MRI Scanners in Radiology. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1659-8821.

Analysis of core processes of the MRI workflow for improved capacity utilization

PURPOSE

To analyze core processes of the MRI workflow and to evaluate efficiency for improved patient throughput and capacity utilization.

METHOD

Prospective data collection was conducted during a four-week time period and a total sum of 160 working hours for each of the two 1.5 T MRI scanners. Three core processes defined the value stream of patient handling before, during and after the MRI examination: i) Scheduling & Registration, ii) Organization & Preparation, and iii) MR scan. Quantitative data was collected for six essential time intervals of the MRI workflow.

RESULTS

A total of 302 MRI examinations were assessed. The workflow analysis revealed that effective utilization of scan capacity during operating hours varied by scanner (Scanner 1: 77 % / Scanner 2: 85 %). Mean process times for were: patient preparation time 18.9 min (±15.1) p = 0.11, scan preparation time 5.7 min (±4.0) p = 0,015, effective scan time 39.6 min (±18.0) p < 0.0001, scan room occupation time 50.9 min (±21.0) p < 0.0001, clean-up time 5.6 min (±3.2) p = 0.001, total patient handling time 69.7 min (±26.3) p < 0.0001, turnover time 13.4 min (±21.4) p = 0.65.

CONCLUSIONS

This study demonstrates the utility and applicability of a standardized core processes analyses for MRI scanning, which identified underutilization of scanning capacities, related to multiple factors, such as punctuality of patients, the number of same day cancellations, the process of placing an IV access and patient transport contribute to underutilization of MRI scanners. Furthermore, proactive patient management and effective communication with patients and referring physicians might have relevant time saving potential in the scan room.

Impact of COVID-19 Workflow Changes on Patient Throughput at Outpatient Imaging Centers

Rationale and Objectives

To determine the impact of COVID-19 workflow changes on patient throughput at the outpatient imaging facilities of a large healthcare system in New York City.

Materials and Methods

COVID-19 workflow changes to permit social distancing and patient and staff safety included screening at the time of scheduling, encouraging patients to use our digital platform to complete registration/safety forms prior to appointments, stationing screeners at all entrances, limiting waiting room capacity, implementing a texting system to notify patients of delays, limiting dressing room use by encouraging patients to wear exam-appropriate clothing, and accelerating MRI protocols without reducing image quality. We assessed patients’ pre-exam wait times, MR exam times, overall time spent on site, and registration for and use of the digital portal before (February 2020) and after (June 2020) implementation of these measures.

Results

Across 17 outpatient imaging centers, workflow changes resulted in a 23.1% reduction (-6.8 minutes) in all patients’ pre-exam wait times (p <0.00001). Pre-exam wait times for MRI, CT, ultrasound, x-ray, and mammography decreased 28.4% (-10.3 minutes), 16.5% (-6.7 minutes), 25.3% (-7.7 minutes), 22.8% (-3.7 minutes), and 23.9% (-5.0 minutes), respectively (p < 0.00001 for all). MR exam times decreased 9.7% (-3.5 minutes) and patients’ overall time on site decreased 15.2% (-8.0 minutes). The proportions of patients actively using the digital patient portal (56.1%–70.1%) and completing forms electronically prior to arrival (24.9%–47.1%) increased (p < 0.0001 for both).

Conclusion

Workflow changes necessitated by the COVID-19 pandemic to ensure safety of patients and staff have permitted higher outpatient throughput.

Free induction decay navigator motion metrics for prediction of diagnostic image quality in pediatric MRI

Purpose

To investigate the ability of free induction decay navigator (FIDnav)‐based motion monitoring to predict diagnostic utility and reduce the time and cost associated with acquiring diagnostically useful images in a pediatric patient cohort.

Methods

A study was carried out in 102 pediatric patients (aged 0‐18 years) at 3T using a 32‐channel head coil array. Subjects were scanned with an FID‐navigated MPRAGE sequence and images were graded by two radiologists using a five‐point scale to evaluate the impact of motion artifacts on diagnostic image quality. The correlation between image quality and four integrated FIDnav motion metrics was investigated, as well as the sensitivity and specificity of each FIDnav‐based metric to detect different levels of motion corruption in the images. Potential time and cost savings were also assessed by retrospectively applying an optimal detection threshold to FIDnav motion scores.

Results

A total of 12% of images were rated as non‐diagnostic, while a further 12% had compromised diagnostic value due to motion artifacts. FID‐navigated metrics exhibited a moderately strong correlation with image grade (Spearman's rho ≥ 0.56). Integrating the cross‐correlation between FIDnav signal vectors achieved the highest sensitivity and specificity for detecting non‐diagnostic images, yielding total time savings of 7% across all scans. This corresponded to a financial benefit of $2080 in this study.

Conclusions

Our results indicate that integrated motion metrics from FIDnavs embedded in structural MRI are a useful predictor of diagnostic image quality, which translates to substantial time and cost savings when applied to pediatric MRI examinations.

Abbreviated MR Imaging for Breast Cancer

Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.

The Impact of COVID-19 on the Use of Radiology Resources in a Tertiary Hospital

BACKGROUND

The coronavirus disease 2019 (COVID-19) has escalated to be a global threat to public health. Analysis of the use of radiology resources may render us insight regarding the public health behavior during pandemic. We measured the influence COVID-19 had on the use of radiology resources in terms of the number of examinations performed, and turnaround time for portable radiography.

METHODS

This study was conducted at a tertiary hospital located in area where the prevalence of COVID-19 infection was low (0.01%). We compared the number of radiology examinations 1) before pandemic (in 2019) vs. during peak of pandemic (January to March 2020), and 2) before pandemic vs. after the peak of pandemic (April to June 2020) via t-tests. We repeated similar analyses for subgroups as follows: gender, age, department (outpatient, inpatient, emergency, screening), body parts, and modality. We also performed a survey of radiologic technologists regarding the turnaround time and rate-limiting step of portable radiography for patients with and without suspicion or confirmation of COVID-19.

RESULTS

Although not statistically significant, the daily number of examinations during the peak of pandemic decreased by 9 percentage points (2,638 vs. 2,413; difference [95% CI], -225 [-489, 38]; P = 0.094). The percentage change was especially notable for children, emergency, and screening department (25, 19, and 44 percentage points, respectively). After the peak of the pandemic, the number of examinations increased back to near the pre-pandemic level (2,638 vs. 2,588; -50 [-317, 218]; P = 0.71). The turnaround time for portable radiography tended to be longer for patients with suspicion or confirmation of COVID-19, with donning personal protective equipment being the major rate-limiting step.

CONCLUSION

The number of examinations decreased during the pandemic, reflecting the tendency of the public to refrain from seeking medical care even in a community of low infection risk. Nevertheless, burden of healthcare providers may not have decreased as much, considering longer turnaround time required for COVID-19 related examinations.

Using Deep Learning to Accelerate Knee MRI at 3 T: Results of an Interchangeability Study

OBJECTIVE. Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Our goal was to use DL to accelerate MRI to allow a 5-minute comprehensive examination of the knee without compromising image quality or diagnostic accuracy. MATERIALS AND METHODS. A DL model for image reconstruction using a variational network was optimized. The model was trained using dedicated multisequence training, in which a single reconstruction model was trained with data from multiple sequences with different contrast and orientations. After training, data from 108 patients were retrospectively undersampled in a manner that would correspond with a net 3.49-fold acceleration of fully sampled data acquisition and a 1.88-fold acceleration compared with our standard twofold accelerated parallel acquisition. An interchangeability study was performed, in which the ability of six readers to detect internal derangement of the knee was compared for clinical and DL-accelerated images. RESULTS. We found a high degree of interchangeability between standard and DL-accelerated images. In particular, results showed that interchanging the sequences would produce discordant clinical opinions no more than 4% of the time for any feature evaluated. Moreover, the accelerated sequence was judged by all six readers to have better quality than the clinical sequence. CONCLUSION. An optimized DL model allowed acceleration of knee images that performed interchangeably with standard images for detection of internal derangement of the knee. Importantly, readers preferred the quality of accelerated images to that of standard clinical images.

Abbreviated Breast MRI: Road to Clinical Implementation

Breast MRI offers high sensitivity for breast cancer detection, with preferential detection of high-grade invasive cancers when compared to mammography and ultrasound. Despite the clear benefits of breast MRI in cancer screening, its cost, patient tolerance, and low utilization remain key issues. Abbreviated breast MRI, in which only a select number of sequences and postcontrast imaging are acquired, exploits the high sensitivity of breast MRI while reducing table time and reading time to maximize availability, patient tolerance, and accessibility. Worldwide studies of varying patient populations have demonstrated that the comparable diagnostic accuracy of abbreviated breast MRI is comparable to a full diagnostic protocol, highlighting the emerging role of abbreviated MRI screening in patients with an intermediate and high lifetime risk of breast cancer. The purpose of this review is to summarize the background and current literature relating to abbreviated MRI, highlight various protocols utilized in current multicenter clinical trials, describe workflow and clinical implementation issues, and discuss the future of abbreviated protocols, including advanced MRI techniques.