Technology: The big question

When it comes to choosing an MRI scanner in the UK, size still tends to be the factor that still trumps other factors: the bigger the better remains the consensus, especially among radiologists.

But could there be a sea change on the horizon?

Stephen Kennedy certainly hopes so. He is UK country manager for Esaote, the company behind a range of MRI scanners which pack a punch way above their weight.

“It’s still the case that when you’re in a room talking to people about a scanner, their first question is almost always ‘How big is it?’. It’s never ‘How good is it?’.

‘By diverting extremity scans, the new scanner frees up whole-body scanners for those who really need them’

“The whole industry has been built on the idea that you have to have a huge tesla [magnet] size; I think that needs to change.

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“Yes, you’ll need the bigger machine for some things, but for many, many others - such as joints, you can get just as good images with a smaller, more dedicated system. And it’s much more efficient as well.”

This is a message that has long been grasped in mainland Europe, and is beginning to take hold in the UK. A growing number of radiologists, and hospital managers, are looking beyond the issue of size and starting to consider instead what best fits their needs.

The bottom line benefits

Among them are Lancashire Teaching Hospitals Foundation Trust, and Direct Medical Imaging, a company in the north west providing scanning services to both private and NHS patients (see some case studies).

The economic benefits of investing in a smaller scanner are clear, says Mr Kennedy. For example, the O-Scan, a compact MRI unit for extremities scanning, uses significantly less space and less power than its larger counterparts, as well as costing much less to buy, install, run and maintain.

“I don’t see the smaller machine as replacing large scanners,” he says. “I think they complement each other. But for MSK work the system can perform just as well and at a fraction of the cost. What’s more, the patient experience is much nicer.”

Anyone who has ever had an MRI scan in a traditional whole-body machine will know what he is talking about. Despite advances and the best efforts of staff, it’s a noisy and potentially claustrophobic experience, and having to lie still in a somewhat unnatural position can be a strain.

The O-Scan, on the other hand, is a quiet machine, and as the patient is not in an enclosed space, is more comfortable for the person being scanned.

‘Fewer visits to hospital, faster diagnosis and commencement with treatment are expected benefits’

For radiologists, however, the key consideration is image quality - and for some, seeing has meant believing.

For example, Plymouth Hospitals Trust took delivery of an Esaote scanner in March, but the order was only made after thorough research, including testing it in situ.

The aim, says Lee Arkins, contracts manager - capital, estates and facilities, was to improve services for patients, as well as help the trust meet its targets and objectives.

“The main focus for our radiologists, and for us, was image quality,” he says.

“We had to be sure that the scanner would do the job we needed it to do. So we had a scanner delivered to us on trial, and we also linked up with a hospital in the north west of England to make sure that the radiologists were completely happy with the images from the scanner. The radiologists are very happy, so we have gone ahead with it.”

The new scanner complements the trust’s existing large MRI machines: by diverting extremity scanning, it frees up whole-body scanners for those who really need them, cutting waiting times and improving access.

Fewer visits to hospital, faster diagnosis and commencement with treatment, and improved resilience if one or more of the trust’s three existing scanners go down are also expected benefits.

Time saver

An added advantage is expected to be saved bed days - because inpatient waiting times for scans will also reduce, making the new scanner an efficient choice.

“By releasing capacity in the main Derriford MRI scanners we will be able to release up to 134 scans per month to be allocated to inpatient MRI,’ explains Mr Arkins. ‘This will significantly reduce the length of wait for an inpatient scan, and potentially save bed days across the trust.”

The radiologists have already taken the scanner to their hearts, he says, and it also helps the trust comply with Any Qualified Provider requirements.

At a time when all trusts are under financial pressure, compact scanners could be seen as contributing to reining in costs in some particularly tough areas. They use far less electricity for one thing, says Mr Kennedy - startlingly so. Power costs for operating the O-Scan for a year are £1,000, compared with around £50,000 for a larger machine.

There are fewer failed images because patients find it easier to keep still, saving staff time and boosting efficiency.

‘The length of wait is significantly reduced, potentially saving bed days across the trust’

There are other savings too: large scanners require expensive helium for cooling but there is no such requirement with the small systems. The footprint of the machines is also considerably smaller, meaning that less space is used, and installation takes just two weeks. “Maintenance costs are a third to a half [of bigger scanners] and capital costs are at least 50 per cent,” says Mr Kennedy.

He believes that smaller scanners are only going to become more popular as the NHS struggles to cope with the twin pressures of rising demand and tightening budgets. But changes in clinical practice will also make change more likely.

“People want to do less with CT and plain X-ray,” he adds. “This obviously puts pressure on MRI scanners. Because a smaller machine is more affordable, it means you can see more patients, cutting waiting times. The pioneers are already seeing it that way, and we hope the message is getting across to others.”

Above all, Mr Kennedy says that size shouldn’t be seen as the “macho” issue it has become in the scanning world.

“We’re not exactly saying small is always the most beautiful,” he says. “But what we are saying is that, for maximum efficiency, you want to get a scanner that’s the right size for the job.”