A Leg Up on the Bariatrics Market

By Chris Gaerig

Toshiba recently introduced a new extralarge knee Array coil for the Vantage Titan MR system.

As the size of the average patient has grown and obesity is on the rise, there is a need for medical imaging equipment to accommodate a larger patient. And though large-bore MR systems are capable of handling the size of bariatric patients, until recently, there hasn’t been a coil large enough to scan them.

“We have these large-bore systems capable of accommodating these larger patients,” said Joel Urick, product manager, strategic development, MR business unit, Toshiba. “In the past, with a 16-centimenter bore, you couldn’t fit these patients into the bores so you never scanned them. Now that we can sit them in the bore, you have to have coils and accessories that can accommodate larger extremities and body parts where some of the current coil technology can’t.”

It is with this thought in mind that Toshiba designed the new extralarge knee Array coil for the Vantage Titan MR system. After receiving comments from customers through Toshiba’s Voice of the Customers feedback portal, the company undertook the process of designing a coil to image the bariatric population. The result is the new knee coil, which has a 22-cm interior diameter for MR imaging and is currently the only coil of its size on the market—giving Toshiba a leg up on the competition.

“One of the reasons we designed it was that all of these large-bore systems are capable of scanning large patients, but you can’t fit those large patients’ knees into the standard-sized knee coils,” said Urick. “Larger patients have a lot of knee problems due to their weight, but there was no way to adequately scan them and get good image quality, so we designed this large knee coil to address that need in the market.”

The coil was designed specifically for imaging the extremities of bariatric patients that could not be scanned by coils that were previously on the market. In addition to its 22-cm interior diameter, the coil is also splittable, so that the top can be removed and a patient can easily be placed inside the coil before reassembling it.

And in spite of the coil’s original design, it can serve other uses in the hospital as well, primarily the imaging of pediatrics.

“I don’t know if that was the initial concept when we designed it, but being that it is transmit-receive with a 22-cm diameter, it would be perfect for imaging the pediatric population instead of putting a huge, adult coil on them,” said Urick. “There are very few innovative coil solutions for pediatrics right now, so this would be a good one for that.”

But creating such a large coil presented problems with regard to image quality. The designers needed to ensure that there would be no loss in image clarity between the new knee coil and those that were currently on the market.

“I think in the initial stages, there were some concerns about making the coil that large,” said Urick. “The further away you are from the anatomy, you can lose a bit of the signal. If you go to smaller and smaller elements with this large interior diameter, you would see some signal loss. But because we stayed with a seven-element configuration, it is very good for both standard-sized patients as well as larger patients.”

Given the size, capabilities, and image quality of the extralarge knee coil, it’s unlikely that Toshiba will invest in the creation of an even larger coil. Through customer feedback and its own tests, the company determined that the 22-cm interior diameter was capable of imaging nearly any patient necessary.

“I don’t think we need to go any larger than this,” said Urick. “This is almost the same size as some of the head coils out there, so we feel that this was a good size to accommodate those patients who can fit on the scanner with the current technology.”

Testing Demand with Mobile MRI

The mobile solution allowed the hospital to avoid construction costs for an MRI suite while measuring the demand for the service with its patient population.

By Chris Gaerig

The purchase of a new MRI system for any hospital is a significant capital investment, but for a facility like the Elizabethtown Community Hospital in Elizabethtown, NY, offering MRI services required a far greater investment if it wanted to have a dedicated unit on site.

The 25-bed hospital is a remote facility that provides health care services to approximately 39,000 people in Essex County. It is nearly 40 miles from the nearest hospital and is located in the Adirondack Mountains, which make it challenging for patients to travel long distances for health care services. So when the hospital’s patients began asking for MRI services, administrators had a decision to make: expend significant capital on building an entirely new wing to the facility or opt for a part-time imaging “facility” to come to them.

“It’s a very small hospital, so if we had to undertake a construction project to build a new wing that would house an MRI unit, it would be a major undertaking and a major expense,” said Jane Hooper, director of community relations, Elizabethtown Community Hospital. “It would involve a capital campaign and a lot more for something that was relatively unknown.”

Instead, the hospital signed an agreement with Insight Imaging, which provides a mobile MRI solution. With this agreement, 1 day a week, Insight Imaging offers MRI services in a mobile trailer outside of the Elizabethtown Community Hospital. The facility is able to schedule all of its imaging procedures during the 11-hour window that the mobile MRI will be on-site.

“It’s like a tractor-trailer truck,” said Hooper. “It parks outside of the hospital on Thursdays. I believe it gets here Wednesday evening. The driver backs the unit onto a concrete slab that we had specially made for it. It’s plugged into an electrical feed that we constructed specifically for this. Then the vehicle is in operation from probably 7 am AM to approximately 6 pm.”

While avoiding construction costs was a significant factor in the hospital’s decision to utilize this mobile MRI solution, the facility is also using this solution to gauge the volume and demands of their patient population.

“MRI would be very expensive to install, and the mobile option allowed us to meet the demands of the area and also see what the potential was for providing those services here,” said Molly Thompson, RT(R)M, medical imaging director, Elizabethtown Community Hospital.

“It fulfills the requirements of our local physicians and patients in terms of volume,” says Hooper. “It was a good estimate of how many procedures we could do in a single day and how many the community was going to demand. We had some sort of idea based on the local physicians—we know most of the local physicians and most are employed by the hospital, so we were able to survey them easily. So we had a pretty good guess that 1 day a week would suffice. Having said that, the nice thing about a mobile unit is that we have the potential to expand if we decide that we need more. We can examine the future market potential and determine if we need 2 or 3 days a week. So the flexibility was there if we needed it.”

One day a week Insight Imaging offers MRI services in a mobile trailer outside of the Elizabethtown Community Hospital.

In the hospital’s current state, however, expansion to include a permanent unit seems unlikely. There have been very few complications with the current model and the staff is able to fit all of their imaging procedures into the 1-day-a-week schedule.

“If the volume grew, we could always add more days if we needed to,” said Thompson. “Right now, we don’t need to. I think we’re still growing and could fit a few more exams in than we currently do.”

In spite of this lack of need for additional services, both Hooper and Thompson acknowledge that the Insight Imaging solution has increased business at the hospital.

“Our volume increased 3% from the year before,” said Thompson. “We just started last year in March with the mobile MRI. It probably has increased a little bit.”

“It has increased business,” said Hooper. “One of the nice things is that we can keep our patients here. So if they see a doctor, that person can also get their MRI here. We’ve made it more convenient. Obviously, from an economic point [of view], you always want to keep your patients as local as you can, but I think part of our mission is just to provide basic services to our local community. So it’s certainly a dual purpose. Economics are always an issue, but we try to keep our patients’ needs in mind.”

Financing Helps Imaging Facility Acquire an MRI

By James Markland

Siemens Financial Services Inc (SFS Inc), the US unit of Siemens’ Financial Services division, recently provided a $3.2 million tax-exempt finance solution to North Oakland—North Macomb Imaging Inc (Michigan Resonance Imaging) in Rochester Hills, Mich, helping them to acquire a new Siemens magnetic resonance system and make significant facility improvements needed to house the new MR system. This outpatient facility is equally owned and operated by three not-for-profit hospitals; Crittenton Hospital, POH Medical Center, and Mt Clemens General. All of their radiologists are board certified in diagnostic radiology and all of their technicians are ARRT registered. Magnetic resonance imaging is all they do.

SFS Inc is a leading provider of business-to-business financial services in the United States. It is a committed business ally that combines deep industry expertise with integrated financing solutions to enhance the efficiency, productivity, and competitiveness of its customers. The company, based in Iselin, NJ, enables business expansion for thousands of customers in the health care, energy, and industrial sectors by providing customized solutions that range from equipment financing and working capital to project and export finance, and insurance solutions.

According to Janelle Spann, executive director of North Oakland—North Macomb Imaging Inc, “The financing enabled our facility to purchase a Siemens 1.5 Tesla Magnetom AERA MR unit with a detachable table. With its new coil technology, the unit enables higher resolution of investigations of prostate tumors, breast biopsies, and enterography studies.” The unit’s open bore design can accommodate larger patients (up to 550 pounds) and those with special needs. The TIM 4G plus Dot (Day Optimizing Throughput) technology, 48 RF channels, and dual density signal transfer give it an improved signal to noise ratio and top of the line performance. Lynn M. Beckham, vice president of Tax Exempt Healthcare, Siemens Financial Services Inc, notes that the AERA unit has recently been approved by the FDA.

“State-of-the-art diagnostic imaging equipment allows health care providers to provide a better level of care and treatment to patients,” said Kirk Edelman, president and chief executive officer, SFS Inc. “With the rapid advancements in diagnostic imaging equipment, it’s important that health care providers have the ability to fund new technology needed to enhance services to the community. We are glad that we can provide the necessary capital to fund projects like these.”

“Many stand-alone imaging centers are looking to become part of a hospital system. Simultaneously, many hospitals are looking to open or acquire outpatient imaging centers in order to enhance their service offerings to the community,” said John Sandstrom, senior vice president and general manager of health care finance, SFS Inc. “Due to our 25 years’ experience as a dedicated health care lender, we are very familiar with this changing landscape and have been able to be both a financier and a strategic business associate. Tax-exempt financing is often not considered for outpatient facilities. The tax-exempt financing for North Oakland—North Macomb Imaging Inc is an example of a solution more people should think about.”

“Our working experience with Siemens Financial Services has been very positive,” said Spann. “The team is very knowledgeable, not only as it relates to putting the tax-exempt financing together, but also of our business model and how we provide service to our patients. This made it very easy for us to work together. Additionally, their professionalism and customer service exceeded our expectations. We look forward to working with them again in the future.”