KLAS Report: Users Rank 1.5T MRI
Toshiba to Bolster MRI Position with Two Works-in-Progress
Cryogenic MRI Coils Could Reduce Noise, Improve Image Quality
Product Showcase: SUREPlaque Software Aids in Coronary Plaque Characterization
New Table Pads Reduce Repeat MRI Exams
UNM and Sandia Research Traumatic Brain Injuries Using Shock Wave Physics

KLAS Report: Users Rank 1.5T MRI

The “Multichannel 1.5T MR: A Performance Study on MR Systems” report was released in September from KLAS Enterprises LLC, Orem, Utah. Overall scores ranged from 75.6 to 92.0 out of a possible 100, with Toshiba America Medical Sales, Tustin, Calif, taking the top spot.

GE Healthcare, Waukesha, Wis; Siemens Medical Solutions, Malvern, Pa; and Toshiba Medical all scored above the MR average Performance Score of 84.7. As a point of reference, all the medical equipment in the KLAS database had an average Total Performance Score of 83.5.

Products evaluated in the survey were GE Healthcare?s Signa HDx 1.5T MRI; the Echelon (overview/technical assessment only) from Hitachi America Medical Systems, Twinsburg, Ohio; the Achieva 1.5T from Philips Medical Systems, Andover, Mass; Siemens Medical?s Magnetom Avanto 1.5T MRI; and Toshiba Medical?s Vantage.

Figure a. Summary of positive vs. negative commentary for all vendors.

A total of 79 provider interviews were performed for this study, with respondents representing 72 unique organizations. The majority of participants were MR directors, managers, and technologists (62%); the type of provider organization was predominantly clinics (42%). Radiology directors represented 13% of respondents, and radiologists represented 4%.

The performance-rating measurements address 40 criteria in four areas:

  • product/technology, such as the vendor?s commitment to technology and if the technology was easy to implement and support;
  • service, which included the quality of training documentation and the quality of telephone/Web support;
  • success indicators, which covered the contracting experience and whether the system lived up to expectations, among other things; and
  • overall business indicators, such as whether the respondent would buy the same system again.

In addition to the 40 data points in the main survey, participants are able to make comments about their experiences. This input covers all topics, including satisfaction with the equipment itself, the vendor, or the service.

All remarks are reviewed by KLAS and categorized accordingly. For the MR study, the positive comments ranged from 43% to 81% with the MR average of 66%. Toshiba Medical scored significantly above the average.

There also was disparity in the numbers of locations that perform some of the complex diagnostic work for which today?s MR systems are lauded by vendors. “One of the interesting things was what percentage of the systems actually are being used for these scans,” says Chris O?Neal, a research manager for KLAS, noting that the largest differences were seen in the more advanced applications, such as cardiac and functional MRI (fMRI). “For example, breast MR ranged from a high of 65% of participants conducting the scans with the unit from Philips going through the other three vendors down to a low of 18%.”

O?Neal believes a number of factors contributed to the chasms, including the type of facility. A general radiology center is likely to perform fewer scans using fMRI than a neurology specialty facility would.

“It also comes down to core availability. A lot of these people are buying [multichannel] units; however, a lot of times, the coils were not yet available or had not been delivered to them with the comparable number of channels,” O?Neal says. “So, they might have a 32-channel MR unit, but a lot of the [necessary] coils had not yet been made available to them?which perhaps resulted in a latent potential being left on the table as far as performance on that scanner.”

This is the first KLAS report on MR; it was generated, as are all other reports, based on interest in the medical community. Much of the provider demand for the 1.5T study was driven by the potential impact that the Deficit Reduction Act of 2005 (DRA) could have on imaging practices.

“Specifically, providers told us that many of the vendors were postulating that [the imaging facilities] could increase throughput by going to a 1.5T multichannel MR, and this move could help offset the financial impacts of the DRA,” explains Jeff Boag, director of medical equipment research at KLAS. “With the DRA looming in the distance, many providers are going the extra mile with their due diligence, and we are pleased that we can help providers mitigate their risk and make informed decisions on their equipment purchases.” And that, according to KLAS, is the ultimate goal of these in-depth industry reports: helping providers learn through the experiences of their peers prior to making any substantial capital investment.

“A provider no longer needs to rely on three to four site visits as their data source, because KLAS is speaking with hundreds of users and reporting on all of their experiences,” Boag explains. “This research gives them a snapshot of what their life is going to be like with this vendor and with this product. Not necessarily that this is what it?s going to cost, but how well it performs different scans, what the response of their service people is?the issues that can make someone?s life happy or miserable.”

The full MR report is available for purchase online at www.healthcomputing.com. KLAS also provides subscription-based vendor access to KLAS ratings, including product-performance scores, performance trends, market segment average scores, and the most recent candid client commentary. Called “KLAS Online,” this service is free to providers who evaluate their vendors. Health care professionals interested in contributing to KLAS should select “For Providers,” then “Rate Your Vendor” from the KLAS home page.

Dana Hinesly is a contributing writer for  Medical Imaging. For more information, contact .

Note: The data and charts used in the compilation of this story are from the “Multichannel 1.5T MR: A Performance Study on MR Systems,” published in September 2006, and have been reprinted with permission from KLAS. Visit www.healthcomputing.com for more information. The report and all of its data is KLAS Confidential Information. ? 2006 KLAS Enterprises LLC. All rights reserved.

Toshiba to Bolster MRI Position with Two Works-in-Progress

The Atlas coils from Toshiba Medical enable multiple examinations without repositioning the patient.

Attendees of RSNA 2006 were able to get a preview of the first 3T MRI system from Toshiba America Medical Systems, Tustin, Calif. The Excelart Vantage 3T, a work-in-progress (WIP), features a new magnet design and a short-bore combination as well as Pianissimo technology, the last of which reduces acoustic noise. Goals of the system are to enable whole-body imaging and spectroscopy that more aggressively captures information.

The Excelart Vantage at both 3T and 1.5T is powered by Atlas technology, and the Vantage 1.5T with Atlas received FDA clearance during RSNA. The 129-element system is an integrated coil concept that allows clinicians to perform multiple examinations without repositioning the patient. The Vantage Atlas also offers an optional 205-cm acquisition range, allowing for feet-first imaging of the entire body, except the neck and head.

“Users can link together the coils for better coverage, including head to toe without repositioning,” explains Bob Giergerich, director of the MR business unit with Toshiba Medical. “Also, the table coil slides for feet-first scanning, providing an extra 1/2 meter.” He notes that the system also allows C-spin without the patient’s head in the gantry, as well as easier-to-position breast and cardiac imaging with increased acquisition speed. Each coil weighs 4 pounds and is 1/2 meter in length.

The company also slightly altered the color scheme and design of the new scanners. “We have included more bore lighting and better air circulation in the bore,” he explains, noting that these features aid in decreasing patient claustrophobia. “And if it’s better for the patient, it is better for the image of the facility.”

Time-SLIP imaging of the abdominal vasculature is one of Toshiba Medical?s noncontrast MRA techniques.

Another WIP that Toshiba Medical showcased at RSNA was the Excelart Vantage Plus powered by Atlas technology—a 1.5T large-bore system. It provides a field of view up to 55 cm. Other WIPs include an 8-channel knee coil, a 6-channel wrist coil, an elliptical-shaped bore to better accommodate obese patients, and JET motion-correction software.

The company also highlighted its seven contrast-free MR techniques, which, according to Giergerich, are crucial in light of the FDA’s June 2006 Public Health Advisory linking gadolinium-containing contrast agents with a rare form of kidney disease.1 “We call these techniques contrast-improved angiography, or CIA,” he says, “and the patient’s blood acts as the contrast agent.” All of these techniques are performed using 3T MR.

—A. Lucas


  1. 1. US Food and Drug Administration. Public Health Advisory. June 8, 2006. Available at: www.fda.gov/cder/drug/advisory/gadolinium_agents.htm. Accessed December 19, 2006.

Cryogenic MRI Coils Could Reduce Noise, Improve Image Quality

Upgrading magnet strength can be an expensive endeavor; therefore, improving a magnet’s signal-to-noise ratio and, in turn, image quality, becomes a paramount concern. m2m Imaging Inc, Newark, NJ, is developing a new solution for improving image quality: the cryogenic coil. m2m’s technology works by cooling a combination of cooled copper and high-temperature superconducting components under vacuum in the receiver coil, reducing noise and thereby improving image quality without increasing magnet strength. The cryogenic coil also enables imaging at a speed of 950 MHz, fast enough to clearly image body parts in motion.

“It turns out that both the magnet and the coils for MR started out with room-temperature copper structures,” explains m2m CEO Richard Hullihen, MBA. “Very quickly, the OEMs of MRI applied cryogenic technology to their magnets. That resulted in a market that went from 0.15 Tesla, which is where the original machines were based, to 3 Tesla. But nobody ever figured out how to solve the material science problems of creating cryogenically cooled coils.”

m2m Imaging was formed in November 2006 when New Jersey-based Supertron Technologies Inc, born out of Columbia University, acquired Australian company Spin Systems Inc. The company’s cryogenic coils are being developed via collaborations with several partners—including Brigham & Women’s Hospital, Boston, with a $2 million grant from the Advanced Technology Program, and sponsor GE Healthcare, Waukesha, Wis. The preclinical coil for nonhuman imaging is being developed with Siemens Medical Solutions, Malvern, Pa.

“The Columbia group actually was engaged in material science research having to do with high-temperature superconductors and the effects of temperature on the behavior of things,” Hullihen explains. “The basic physics principle says that as you cool electrical components and circuits, two things happen: The impedance and resistance of those circuits go down, and the noise, which is a result of thermal activity in the materials, also comes down. So, you wind up with lower resistance and lower noise.”

But trying to cryogenically cool a vacuum vessel in the bore of a magnet at a very high field was an overwhelming challenge for developers, Hullihen says; signal strength became the focus, and noise reduction fell by the wayside—until now. “We think we can achieve something on the order of doubling the signal-to-noise performance of an MR machine,” he says.

One of m2m’s principal investors is Amphion Innovations plc, New York City. Amphion CEO Richard Morgan says, “Obviously, there are very few ways that you can get really rich information out of the body. [We have] entered an established marketplace offering a fairly significant change in signal-to-noise ratio and, therefore, the functionality and performance of both existing systems and then potentially new systems. This could either produce the same quality images at a significantly lower cost, or you could pay the money and get a dramatically superior image.”

The cryogenic coils work in any existing MRI scanner, and the replacement process is painless, Hullihen notes. m2m hopes that clinical trials will take place in 2007, and he anticipates the product shipping to North America by the end of the year. “Part of it depends on our partners,” Hullihen says, “but in terms of our own R&D programs, it looks like we should be ready in 2007.”

?C. Vasko

Product Showcase: SUREPlaque Software Aids in Coronary Plaque Characterization

A technical collaboration between Vital Images Inc, Minneapolis, and Toshiba Medical Systems, Tustin, Calif, has produced the new SUREPlaque software system for coronary plaque characterization and quantification. Although compatible with any CT system, the SUREPlaque system offers additional functions when used with Toshiba Medical’s systems. Initially developed on Toshiba Medical scanners, the application has been integrated into Vital Images’ Vitrea 3.9, along with other cardiac-focused enhancements.

Robb Young, senior manager of cardiology CT at Toshiba Medical, notes, “One of the things that coloring doesn’t give you is quantification, and that’s really what SUREPlaque gives you—the ability to not only visualize the vessel wall and soft plaque within the vessel wall, but also look at measurement and quantification of that. That’s possible only because of having an image with a good-enough low-contrast resolution. It just gives clinicians better quantitative information on how to treat the patient.”

3D volume-rendered image using SUREPlaque to visualize and quantify this lesion in the posterior descending coronary artery. There is a 48% narrowing of the vessel and a plaque burden at the most stenotic area of 74%. The remodeling index along the vessel wall is measured at 94%.

SUREPlaque provides color coding of vessel walls as well as noncalcified and calcified plaque for easy reference and viewing; the software also offers improved visualization of lesion boundaries and plaque types with automated measurement and quantification tools. Additional functionalities available with Toshiba Medical’s CT images include measurement of plaque burden. Vitrea 3.9 also offers new tools for probing coronary arteries and increased capacity for handling large data sets.

“With quantification tools that go well beyond color coding and positive remodeling indexing, SUREPlaque not only detects plaque deposits in the lumen, but also within the vessel wall,” said Susan Wood, PhD, executive vice president of marketing and clinical development for Vital Images.

Young adds, “You see soft plaque routinely on a 64-slice, and because of the sensitivity of Toshiba Medical’s detectors, we have very good low-contrast resolution. If you’re any CT scanner, you can color-code. If it’s an image with good low-contrast resolution, you obtain a lot of additional measurement details.”

Visit www.vitalimages.com for more information.

New Table Pads Reduce Repeat MRI Exams

At the 2006 RSNA Annual Meeting, Patient Comfort Systems, Hayward, Calif, presented the results of a study showing a 56% decrease in repeat MRI sequences when using the company’s TEMPUR pads. Patient callbacks dropped 50% when using the pads, which use TEMPUR material—developed by Tempur-Pedic Inc, Lexington, Ky—that conforms to the patient’s body.

In the study, 200 lumbar MRI examinations were reviewed: 100 with traditional MRI table pads and 100 with the company’s TEMPUR pads. With the traditional pads, 18% required at least one sequence to be repeated, and 8% needed the entire procedure repeated because of motion artifacts. With the Patient Comfort Systems’ pads, only 8% required one sequence repeated, and just 4% needed the entire examination repeated.

The Cine Step pads from Patient Comfort Systems provide radiologists with a full range of motion, 1/2 inch at a time.

“Our theory was that patients are moving because they’re in pain,” explains Peter Rothschild, MD, president and founder of Patient Comfort Systems. He explains that standard MRI table pads wear out after a while and “bottom out”—when a patient simply pushes on the pad, he or she can feel the table.

Pads from Patient Comfort Systems don’t bottom out; in fact, they are heat activated to keep patients more comfortable for longer. The company offers a line of table pads, knee wedges, and positioning cushions that redistribute pressure away from weight-bearing contact points, such as the shoulder blades, head, heels, and hips. Also, all of Patient Comfort Systems’ pads feature an antislip bottom, so that when patients get on and off the table, the pads don’t move.

“We’re trying to make things comfortable and solve issues that no one else is looking at,” Rothschild says, noting that to help reduce noise inside the magnet, the company has released MRI Noise-Reduction Ear Pads. “They fit inside the head coil and are made of a specialized foam that absorbs noise, and that significantly increases comfort.” The pads are shaped to fit patients’ ears.

The company also offers Cine Step pads, which come in a set of 10 1/2-inch pads that are bound by Velcro straps. “Many physicians want to see motion studies—they want to see the neck move in full range,” he explains. With Cine Step pads, the technologist puts the stack behind the patient’s head, takes the image, removes one pad, takes another image, and so on, providing 5 inches of motion range.

To help spread the word about the study results and its new product line, Patient Comfort Systems has rolled out a national radio campaign, targeting both patients and physicians. “[We want to] explain the difference that our products can make in the MRI process and to encourage patients to seek out imaging centers that offer this extra level of comfort,” Rothschild says.

For more information, visit www.patientcomfortsystems.com.

—?A. Lucas

UNM and Sandia Research Traumatic Brain Injuries Using Shock Wave Physics

The research could contribute to the development of successful preventive measures

By Renee DiIulio

Traumatic brain injury (TBI) can occur within the first millisecond after impact, according to research led by Paul Taylor, PhD, in multiscale dynamic materials modeling at Sandia National Laboratories, Albuquerque, NM; and Corey Ford, MD, PhD, a neurologist in the department of neurology and the MIND Imaging Center at the University of New Mexico Health Sciences Center, Albuquerque, NM.

Sandia engineer Paul Taylor (left) and Corey Ford, neurologist at the University of New Mexico?s Department of Neurology, study models of early traumatic brain injury.

The knowledge isn’t necessarily new, but the research could lead to further information about the physical mechanisms by which brain injury occurs. Currently, more than 5 million Americans live with TBI-associated disabilities.

The research is based on the shock physics computer code CTH, which was created at Sandia. “This code, or computer program, originally was developed to simulate the formation and propagation of shock waves that are generated within materials as they interact with one another during high-velocity impact and penetration events,” Taylor says. Shock waves tend to permanently alter the molecular or microstructural features of the material through which they pass, often with disruptive effects, he notes.

Using the CTH code, the researchers simulated the high-velocity impact and penetration phenomena that occur when an unrestrained person’s head hits the glass windshield of an automobile in a 34-mph head-on collision with a stationary barrier. The program was created using the digitally processed CT scan of a healthy female head and specific material descriptions representing the mechanical response of various biological materials, such as bone, brain tissue, and cerebral spinal fluid.

“Our fundamental observation thus far is that wave action occurs in the brain in the first millisecond after impact and leads to focused pressure and sheer stresses that could damage neural tissues,” Taylor explains. “The impact waves reflect from the skull and focus in different areas depending on the skull geometry and direction of the blow.”

Different angles of impact can, therefore, have very different outcomes. As explained by Ford, “One patient could return to his or her regular life with no negative consequences, while another with a similar injury intensity could develop persistent memory, behavioral, and other disabling cognitive changes.”

This sagittal view shows the compressive pressure in a head model (with the glass positioned at the right of the head); the pressure is highest at the impact of Coup site.

Future research is likely to incorporate additional imaging modalities. Ford notes that a standard medical CT scanner—the PQ2000 Picker Single Slice—was employed to develop the head model, but that CT resolution was suboptimal for the best resolution. The axial images used a matrix of 512 x 512 voxels with slices measuring 3 mm; in the plane of each slice, the voxel dimensions were 0.39 x 0.39 mm. “We chose CT images for our basic model because CT shows skull, brain, and fluid very well,” he notes. “We are currently creating a better, higher-resolution model of the head for further studies using additional imaging techniques, such as MRI.” Rather than a ratio of 0.39 mm to 0.39 mm to 3.0 mm, Taylor would like to have a 1:1:1 mm, which can be achieved with MRI and produce higher resolution.

This future research will be based on use of the CTH code. One of the researchers’ goals is to explore mitigation designs that could reduce or prevent TBIs in specific circumstances, including car accidents and warfare. “Our current results are considered preliminary,” Taylor notes. “We are pursuing additional funding in order to complete this work and extend it to related topics.”

To do this, the researchers will improve their structural model of the head and assignment of material properties, model different impact scenarios to understand how energy is focused, and correlate predictions from the model with real-world head-injured patient scans.

Additional simulations, using different angles and different scenarios, will yield more information as well. “Our simulation capabilities allow us to investigate the effects of blast wave loading to the head as is experienced by soldiers who suffer such conditions brought on by detonating improvised explosive devices during combat,” Taylor says. “Subsequent simulations could then be conducted to investigate mitigation strategies for prevention of TBI during impact or blast scenariosby including protective headgear into the simulations, for example.”

Renee DiIulio is a contributing writer for  Medical Imaging. For more information, contact .