New tool for the COVID era: Portable MRI

In particular, the 2020 pandemic emphasized the need for rapid access to reliable medical results for both patients and their physicians.Appearance of Rapid antigen test For example, in the case of COVID-19, the way of thinking about how to deal with the disease and how to prevent the spread of the disease is changing.

But what if you could think bigger? What if one of the most useful diagnostic tools in healthcare could be moved to the bedside of a hospital room without having to move completely to another building or building to take advantage of it?

For decades, we have used magnetic resonance imaging (MRI) to create detailed anatomical images of internal organs and structures.Now, improvements in radiographic imaging technology have allowed the industry to build smaller ones. Low magnetic field Move the MRI to the clinical environment. It’s basically the first portable version of this device. For an emergency physician like me, bedside imaging has the potential to open up all areas of potential.

Further research is needed on this innovative device, but early results are promising and doctors and hospitals may begin to imagine how to use portable MRI. Others have restricted the use of such units. Details about those features.

Here’s a scenario that fits our time: you get sick with COVID, begin to experience neurological symptoms that are consistent with your chances of a stroke (headache, slurred speech, weakness, etc.) and end up in the ER. I will. But when nurses and doctors enter your room and begin to evaluate you, they do not come alone. Instead, bring a Point of Care (POC) MRI that is only 57 inches high.

Doctors do simple tests, but instead of calling the radiologist suite to schedule an MRI scan on a machine that is often found in the basement or elsewhere in the hospital, this mini-MRI is ready at the bedside. it’s finished. .. Imaging is performed there. Results will begin to appear within minutes. It was immediately possible to know if a stroke required a thrombus-destroying drug such as tissue plasminogen activator (tPA) or if there was abnormal swelling in the brain.

Perhaps the sick newborn is in the intensive care unit (ICU), on the monitor, connected to a wire, and the feeding tube is in place. Imaging is needed, but “getting a newborn to MRI can be a huge production,” said Christine Glastonbury, interim director of neuroradiology at the University of California, San Francisco. “Therefore, portable MRI in the neonatal ward is magical for this kind of thing.”

A machine called Swoop Hyper Fine.. You can plug it into a standard outlet and then control it with a wireless tablet such as an Apple iPad. Khan Siddiqui, Chief Medical Officer at Hyperfine, says new users need about 30 minutes of training to operate and learn to operate the system. (I spent more time learning how to collect blood.)

The potential benefits of this point of care technology for the brain are immeasurable. For example, the entire diffusion-weighted MRI sequence of a stroke can be completed in 9-11 minutes, says Siddiqui. And the resolution and level of anatomical detail that can be seen with a traditional MRI scanner is nothing short of extraordinary. If Swoop can get close to such details, it’s not clear yet, but it constitutes a big breakthrough.

“We have changed the notion of having to take a patient to an MRI to the notion of delivering an MRI to a patient,” said Yale University’s Neurocritical Treatment, an academic partner working with Hyperfine. And says Kevin Chess, head of the Department of Emergency Neurology.

As I write this, my friend’s daughter is in the hospital ICU for COVID-19. Due to heart, lung, and abdominal problems, her blood pressure is too unstable to safely carry to a CT scan several floors away from the ICU. In situations like her, devices like Swoop can save lives.

According to Siddiqui, Hyperfine’s mission is to “democratize healthcare by making medical images available worldwide.” That’s probably a big ambition, as about 4.7 billion people lack access to all forms of medical imaging. Still, the device is “portable and cheap, so we should be able to ship it to places where we can really change the drug in other countries,” says Glastonbury at UCSF. “I love this kind of genius invention.”

As doctors, we can wait hours to schedule an imaging test and are worried that the patient’s condition will worsen during that downtime. In the world of portable MRI, we can get answers instantly and patients don’t have to leave bed for us to get them. In addition, MRI technology is much safer than CT scans because it does not emit ionizing radiation. Ionizing radiation can cause cancer after a few years.

There may also be cost savings. “Patients may be hospitalized overnight for MRI,” says Susan Lewis, an emergency physician at Scripps Mercy Hospital. “This will reduce hospitalization costs. MRI will be available faster, cheaper and safer. [emergency] Department. “

Traditional MRI equipment is very expensive, has strong and heavy magnets, and needs to be supercooled with liquid nitrogen or helium, so it should be placed in a bunker-style copper-shielded room.They consume some 35 times more energy Than devices like Swoop. Traditional MRI is also very noisy for patients, thin scanning tubes can be exorbitant for patients with claustrophobia (although open MRI is also used), and the strong magnetic field generated is Passivation metals on the body (rods, screws, plates, bullets, etc.-no scans at all. According to Siddiqui, it is now possible.

But there are always trade-offs. For one thing, the quality of the images produced by the Swoop system is not perfect. Although it has improved significantly over the last two years, Chess said, “We still need to improve a lot, but we are just the beginning of this journey.” Deep learning (((AI technology) Offers the possibility of shortening the scanning period as well as optimizing the image.

Undoubtedly, the importance of such devices will be related to image quality. But as a doctor, what I really want to know at bedside is whether the disease exists. For example, can strokes be identified even if the Swoop image has a slightly lower resolution? This is a basic level consideration.

In a prospective study published in JAMA Neurology In September, Chess and his team conducted a neuroscience ICU at Yale New Haven Hospital in critically ill patients with a portable MRI machine that included stroke, brain tumors, and traumatic brain injury in 29 of 30 patients. We found that we identified important neurological findings in theAnn Overview Was announced in NeurologyMeanwhile, we considered the use of POC MRI scanners in stroke and cerebral hemorrhage and concluded that low-field MRI systems appear to be safe and viable in complex ICU environments.

Second Overview Performed on 36 stroke patients, all tests found “pathological lesions”, but were 89% sensitive to all types of cerebral hemorrhage. So I don’t know if these were important, but I missed a tenth. The authors conclude that more work is needed to evaluate this approach across various cerebral hemorrhage characteristics.

Hyperfine was FDA-approved in August and used Swoop for brain imaging in all age groups. According to the company, at least 25 facilities, including Massachusetts General Hospital and Yale New Haven Hospital, already have these scanners. In addition to the demand associated with COVID-19, the company was able to speed up manufacturing due to advantages such as being able to clean the machine in minutes (rather than sterilizing the MRI suite), says Siddiqui. The machine is used, among other things, in neurological ICUs, pediatric ICUs, outpatient neurology clinics and stroke rehabilitation centers. The Gates Foundation recently purchased 20 scanners for screening purposes to examine infant choking and brain development in malnourished children.

Hyperfine’s innovation with Swoop stems from its small size, portability, and some proprietary technologies. Although Swoop has many benefits, evidence-based studies in different settings are still needed to determine its clinical yield and performance. (Half a dozen papers have been reviewed, according to Siddiqui.) Since the 1980s, there has been a series of studies on the use of low-field scanners. Demonstrate promising result With such technology, “the last 20 years of MR sequence development, and the technology to improve image quality at 1.5 Tesla (high magnetic field), never happened at low magnetic fields,” says Siddiqui. “This is where we need to keep up with our research.” The resurgence of interest in low-field MRI using small, cost-effective, and easy-to-install scanners demonstrates its feasibility. use Intraoperative, In Newborn baby ICU, And in the orthopedic officeLimb scannerUse to imagine the arms and legs.

More clarifications in the clinical arena include who will perform the scan and which patients and conditions the technology will use. How is the quality of the images obtained here compared to traditional MRI images? Will the machine replace CT or high-field MRI, or will it be used more for screening or dedicated purposes? How well can you diagnose conditions such as stroke, various types of cerebral hemorrhage, and tumors? And who maintains POC MRI quality control?

Many questions remain. Then again, the wheel mini MRI just left the start gate. “We are working and others will be doing research,” Chess said.

Let’s see what happens to Swoop. My colleague and I want one (or two) of these to go through the ER door during this pandemic. In fact, we’ve been joking before, but if we can perform an MRI on everyone who comes in, we know what’s wrong with them. That wish may be closer to realization than we think.