There are a wide variety of patients that need to have magnetic resonance imaging (MRI). Some patients' situations have a level of pain involved. Additionally, the patients who come to the radiology department are different sizes. Because of these factors and many more, the imaging experience and the ability to be scanned varies from patient to patient. Patients who are in a lot of pain, often do not fit the standard conventional size coils and some patients who are younger or older may have more issues than others. This is especially true for patients with unexpected complications, such as a severely broken bone. The goal of the radiology department, in challenging various situations then, is to image the patient to the best of their ability.
Difficult to image situations:
- Patients with lower back pain may be difficult to image, because they may struggle to hold one position for a long time. Additionally, they may struggle to bend or straighten their back or spine to lay flat on their back. It also may be hard for them to hold their breath if a specific scan requires breath-holds.
- Patients being imaged for broken bones or for simultaneous injuries (called polytrauma) may struggle to be imaged if their injury has caused their body to be an unusual shape in the region of interest, like if their bone is out of alignment.
- Patients with casts also have the potential to cause difficulty imaging. This is because hard casts only allow the patient to move a certain way. For example, if the patient has a plaster ankle cast, they may be unable to move their foot to the position that is required by a dedicated coil. In most cases, the plaster cast can enter the coil. However, if the doctor had to use metal of any kind, such as rods or pins, the patient should not be imaged using MRI.
- Larger or tall patients may not fit in the traditional, dedicated coils due to their size. Because of this, it can be difficult to receive an excellent signal-to-noise ratio, which is increased by the coils being close to the body, possibly resulting in lower image resolution or possible artifacts.
- Patients who are on critical-care or life-support devices pose some difficulties for MRI, because the radiographer has to work around their equipment. Critical-care and life-support devices must also be MR Safe or MR Conditional to be able to safely be in the MR suite. This equipment may also be big, bulky and hard to move around.
- Patients who have a cervical spine collar could be difficult to image. A cervical spine collar goes around the neck and is designed to hold a patient's head, neck and spine in a particular position to avoid further injury. This collar must be MR Safe or MR Conditional for the safety of all those involved to be in the MR imaging suite. Like patients with casts, these patients can be difficult to position.
- Patients who have an abnormally curved spine can be difficult to image, such as those with kyphosis or lordosis. Kyphosis is the condition of having a spine that rounds forward more than usual and may sometimes be called hunchback. Lordosis is the condition of having an exaggerated curve in the spine. Patients with either of these conditions may have trouble laying flat for long periods of time.
Flexible, durable coils may be the solution
With patients who may not fit the mold for traditional dedicated coils, radiology departments may need to find another solution. These traditional coils are rigid and hard, and they are made to fit the average person. Young patients typically are too small for these coils to be against their body, while people who are larger or taller may be unable to have the coil around their body. The same could be true for badly injured patients who need to have MRI, and they may not be able to fit the coil due to the possibility of misshapen body parts. The question for radiology departments then comes down to finding a creative way to use the coil or finding a different coil to use.
The solution, however, is on the horizon, possibly in the form of more flexible and durable coils that may be more blanket-like. Certain companies have begun innovative work in the shape and design of coils to advance the usage of coils, including comfort for the patient, versatility of usage and increased productivity for the technologist. Some of these coils are blanket-like, allowing the coil to lay over the patient or be wrapped around the area being imaged, something that was not possible with previous coils. Wrapping the coil around the anatomy has multiple benefits, such as getting closer to the anatomy of interest and increasing the signal-to-noise ratio to help improve image quality. For some areas of the body, these coils may need to be paired with positioners. This allows the imaging of those patients who do not fit the standard coil, and personalizing the MR experience while providing similar results to that of the past.
As radiologists and patients alike look to the future, they should consider the coil and what they want to see in it. The newest coil designs may allow for more imaging of challenging patient positions or of those who do not match the average patient. This is especially important, since a large number of patients may need accommodations while being imaged. Luckily, the new wave of more personalized, lightweight, durable coils has already begun.
For more information on flexible and durable coils, please read SIGNA Pulse "A lighter, more flexible and comfortable way to scan."
1. Utaroh Motosugi. "A lighter, more flexible and comfortable way to scan." SIGNA Pulse. Autumn 2018. Web. 1 May 2019. <http://www.gesignapulse.com/signapulse/autumn_2018/MobilePagedArticle.action?articleId=1444517#articleId1444517>.