New Outpatient Imaging Center Offers More Efficient, More Patient-Friendly MRI Exams

Opening its doors to patients just this month, a new Mass General Brigham Outpatient Imaging Center at Assembly Row in Somerville not only provides a convenient location for an array of outpatient exams but also offers access to cutting-edge imaging techniques and the latest innovations in workflow optimization, enabling exam times of 30 minutes or less. Taken together, the many features of the center add up to an unparalleled patient experience, and what Susie Huang, MD, PhD, a neuroradiologist in the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital, who played an integral role in developing the center, describes as a "model practice of the future."

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Making Imaging More Accessible

The original impetus for the new outpatient imaging center was a need for additional MRI capacity to keep up with the ever-increasing demand for exams.

"We were so backed up, we were scheduling MRI appointments six or seven weeks out," says Jeremy Herrington, clinical director of MRI & Off-Campus Imaging in Radiology, who was also indispensable to the design and implementation of the center.

But once the department identified a new space—an empty 8,000-square-foot retail space under the Mass General Brigham corporate offices in Assembly Row—Herrington and colleagues also saw an opportunity to enhance the overall patient experience with imaging.

Going for an MRI exam can be a stressful experience. Many patients find the process of lying in the narrow bore of a scanner for the duration of the exam unsettling or even harrowing. Simply getting to the hospital, finding parking, and so on can easily compound a patient's anxiety about the exam. And of course, the very fact that the exam has been ordered means there's some cause for concern about the patient's health, a major source of anxiety itself.

In addition to adding more MRI slots for Mass General patients, the new imaging center was designed to alleviate the stressors associated with getting an MRI, beginning with the often-unnerving experience of driving to the main campus of the hospital in downtown Boston. The location of the center alone—a stone's throw from I-93 in Somerville and just across the river from Everett and Medford—will be a relief to patients, and because Assembly Row is home to an array of shopping and dining options, they can check other items off their to-do lists while they are there. If they only want to visit the imaging center, a complimentary valet service removes any worry about parking.

The entrance to the center itself was conceived to put patients at ease. When they walk through the front doors, they will find themselves in a large, well-lit open space wreathed with calming art. In both look and feel, the space is about as far from an unwelcoming "clinical" environment as one can get.

Not that they will spend much time in the waiting area. "We don't expect patients to be sitting there very long," Herrington says. "An assistant will receive them and walk them back to the changing area almost immediately."

Here is where several of the most important innovations of the imaging center start to come into play.

Reducing Exam Times by Optimizing Workflow

The benefits of the new outpatient imaging center extend well beyond the convenience of its location. Herrington and colleagues considered every aspect of the scanning process in developing the space: not least, the physical flow of patients and MRI technologists and how revising the flow can dramatically reduce the length of the exams.

To this end, the imaging center includes three scanner bays and four patient prep bays separated only by a nine-foot corridor. (The mismatch between the numbers of scanner and prep bays was by design, Herrington says.)

"We recognize that we're still in the middle of a city and patients might still arrive later than their appointment times. With the resulting delays, there is a chance we will have four patients waiting to be imaged in the three scanners."

The physical proximity of the bays contributes to the reduced exam times found at the imaging center.

Here's how. Each scanner has two detachable tables that can be moved back and forth between the scanner bays and the patient prep bays across the hall. So even as one patient is in the scanner, the technologists can be getting the next patient ready: completing the screening questionnaires, getting the MRI coil in place, making sure the patient is as comfortable as possible, with blankets, earplugs, etc. This not only helps with imaging efficiency—an important goal for the hospital—it also leads to the patient receiving more personal attention and feeling less rushed than if they were prepped quickly in the scanner bay immediately before the exam was scheduled to begin.

When a scan is completed, the patient is wheeled into the corridor and the next patient is wheeled directly into the scanner bay. Once this is done, the first patient is wheeled into the patient prep bay, from which they can be comfortably discharged.

Also of note: the center boasts three new 3T Vida MRI systems, the latest generation of wide-bore scanners from the medical device company Siemens. The wide bores can accommodate different body sizes while alleviating anxiety for patients who experience claustrophobia, all of which play an additional role in putting the patients at ease during their exams.

Fast Imaging Offers Further Improvements in Exam Times

The convenient location and optimized workflow aren't the only ways the imaging center is enabling shorter visits for patients. Dr. Huang and colleagues are also reducing the length of exams by incorporating specialized MRI protocols. Here, they looked to a longstanding collaboration between researchers at the Martinos Center for Biomedical Imaging at Mass General and engineers at Siemens, a collaboration that has yielded new parallel imaging technologies enabling what the researchers have dubbed "fast MRI."

Fast MRI offers tremendous benefits. The typical MRI brain exam, for instance, can take up to 40 minutes, producing a considerable burden: a burden in terms of cost and efficiency—because of the relatively low throughput associated with the exams—but more importantly a burden to the patient, who needs to lie still in the scanner for long periods of time, a requirement that can prove uncomfortable and even distressing. By incorporating fast MRI into its exams, the outpatient imaging center at Assembly Row helps relieve this burden, reducing the exam times to 30 minutes or even less.

In fact, scans using the technology aren't just faster, enabling higher throughput and increased efficiency for the center and less anxiety and discomfort for the patient, they are better. This counterintuitive proposition—spending less time on a scan can give you a higher-quality image—can be explained by considering the problem of motion artifacts: anomalies in an image that result from the patient squirming or otherwise moving around during a scan. Developers of the technology have found that patients are better able to hold still for the relatively short lengths of time required for fast MRI. This leads to fewer motion artifacts and thus results in better images.

Initially, the imaging center will offer 30-minute table times for commonly performed exams in three-body systems. The neuroimaging effort has been spearheaded by Dr. Huang and colleagues in the radiology department, including John Conklin, MD, MS, Otto Rapalino, MD, and Pamela Schaefer, MD; the body imaging effort, by Mukesh G. Harisinghani, MD; and the musculoskeletal effort by Jad Husseini, MD. Oleg Pianykh, PhD, director of the Medical Analytics Group at Mass General, will track scanner-level data and create dashboards to achieve even faster turnaround times while preserving image quality for better patient care.

Evaluating the Time Savings With Fast MRI

Mass General radiologists were already working with two fast MRI techniques when they started planning the outpatient imaging center at Assembly Row. Both were developed by researchers at the Martinos Center for Biomedical Imaging, including Kawin Setsompop, PhD, Berkin Bilgic, PhD, and Steven Cauley, PhD. Simultaneous multislice (SMS) imaging and Wave-CAIPI (controlled aliasing in parallel imaging) take advantage of parallel imaging strategies, which use arrays of MR receiver coils to reduce the amount of information needed for image reconstruction, and thus the amount of time needed to complete a scan. SMS is used with diffusion-weighted imaging (DWI) and other two-dimensional slice-by-slice imaging sequences; Wave-CAIPI, with high-resolution three-dimensional MRI sequences, which are increasingly becoming the workhorse for high-quality, comprehensive exams in the brain and other areas of the body.

In a study reported last year in the journal Academic Radiology, Dr. Huang and colleagues, including first author Min Lang, MD, a resident in the department, evaluated the time savings achieved with the fast MRI techniques in outpatient brain imaging. Previous studies had looked at the diagnostic image quality of scans acquired using fast MRI, as compared to conventional scans, but the operational benefits of the techniques—their impact on imaging throughput and patient access to MRI—were less well studied.

To assess the time savings, the Mass General researchers compared the acquisition times for the five most performed brain MRI protocols at the hospital—brain without contrast, brain with and without contrast, multiple sclerosis, memory loss, and epilepsy protocols—from before and after implementation of the techniques. They found that implementation of fast MRI led to significantly decreased acquisition times on both 1.5T and 3T scanners, with an overall 42% decrease in the median scan time.

It Takes a Village

Conceptualizing the outpatient imaging center at Assembly Row and ultimately making it a reality has truly been a team effort, says David A. Rosman, MD, MBA, Vice Chair for Enterprise Service in the Mass General Brigham Department of Radiology, with a multidisciplinary group drawn from across the department, including radiologists and researchers John Conklin, MD, Steve Cauley, PhD, Pamela Schaefer, MD, and Otto Rapalino, MD. Dr. Rapalino was the first radiologist in the group to start thinking about reducing the length of imaging exams by incorporating advanced MRI technologies. After working with Martinos Center researcher Thomas Witzel, PhD, Dr. Huang and colleagues launched a collaboration with the center's Kawin Setsompop, PhD, Berkin Bilgic, PhD, and Steve Cauley, PhD, to implement the Wave-CAIPI technology now in use.

The MR Operations team, including Herrington and MR Quality assurance manager Seretha Risacher, have also played a critical role in developing the outpatient imaging center and ensuring that quality and patient safety remain at the forefront of the new imaging center's priorities.

The effort has also benefited from the dedicated support and expertise of collaborations managers, applications specialists, and engineers at Siemens. academic-industrial partnerships have proven time and again to accelerate the development and translation of cutting-edge technology for medical imaging, says Dr. Huang. The new imaging center at Assembly Row harmonizes the clinical expertise of radiologists and radiologic technologists with the technical innovation from cutting-edge research and workflow optimizations, all for the benefit of the patients who will experience shorter wait times and ultimately faster and better care delivery.

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