MR Insights

Industry Insights from Those in the Know

Neonatal MRI – Opportunities and Obstacles of Scanning NICU Patients

An Interview with Featured Expert Diane Wilson

Diane Wilson is a Neonatal Nurse Practitioner in the NICU at the Hospital for Sick Children (SickKids Foundation), which is affiliated with the University of Toronto, in Canada. Diane has more than 30 years of experience in Neonatology with a focus on Neonatal Neurology, and was instrumental in the development of the Neonatal Neurocritical Care Unit (NNCU) at SickKids.

Scroll down for insights from our Q&A session.

Q. How valuable is having an MRI system in place for neonatal patients?

A. MRI is definitely the mainstay of our treatment in neonatal brain injury. We use the MRI to help us not only make decisions on the spot about treatment that may be needed for patients, but also, and probably most importantly, to help us prognosticate about what the future looks like for these very fragile, tiny patients. So, it’s extraordinarily important.

Q. What, if anything, limits the use of the MRI in traditional neonatal care practices?

A. In a large hospital — and most of our NICUs are within large academic hospitals or even community hospitals that also house adult patients — there is competition for MRI services in the traditional setting where there’s not an in-unit specific MRI for neonates. So, we’re constantly competing with adult patients, who, for whatever reason, may have priority access to MRI scans. And so the timing of the ability to access the test is limited by that competition. We need quick access, in a lot of cases, to make on the spot decisions.

Q. If you don't have an MRI system available, what alternatives are there?

A. If there’s no MRI system available, the biggest and most useful alternative would be ultrasound. However, the limitations of ultrasound are that you only have a tiny window to view the brain. For example, through the fontanel, or the soft spot on the baby’s head. So, you’re getting limited views of the underlying brain tissue. Whereas with MRI, you’re able to see the deep structures of the brain and see in detail, areas that may be injured or where bleeding might be occurring.

Q. So you get greater clarity?

A. Yes, for sure. Better clarity and more detail.

Q. What's the most challenging aspect of using MRI as part of neonatal care?

A. It’s moving the patient, for sure. A lot of these patients are critically ill. They’re on ventilators. They’ve got IV fluids running. Some of them are very tiny. And so having to move those critically-ill patients out of their ICU environment to another part of the hospital is a difficult process. It takes a long time. It takes a lot of manpower, and it needs to be done well to keep the patient safe throughout the journey.

Q. When you consider a point-of-care MRI System how do you see it impacting neonatal care?

A. A point-of-care neonatal MRI system provides us with the opportunity to do serial MR imaging in a very simplified manner, in that we don’t have to move the patient off the unit and outside of the care environment. The MRI system is right in the neonatal intensive care unit.

There are system now available, designed specifically for use within the NICU, meeting the unique needs of neonatal patients.  Whereas, the other traditional MRIs that we’re used to going to, are very large machines that are often housed in basements of hospitals, because that’s the only place you can put something that weighs that much.

And so we’re able to do imaging at any time during the day or night, without the scheduling challenges of using traditional MR systems in Radiology.  With the point-of-care MRI system specific to the NICU patient, the travel time to and from the unit is reduced. The safety because of that reduction in travel time and the reduction of the time outside of the intensive care unit is extremely .

Q. For clarity, when you say a serial MRI, what exactly do you mean by that?

A. You could image a patient every day, for example, if you wanted to follow the evolution of an injury over time. That’s something that we’ve been able to do with ultrasound – to do serial ultrasound imaging.

However, as I said before, ultrasound is limited to that tiny window of the fontanel and only seeing certain parts of the brain, whereas with MRI, we can see the entire brain, really, and even the deep structures of the brain. This level of care is only possible with an MRI system readily available within the NICU. 

Q. Let’s touch on productivity challenges. Under a traditional scenario, what are some of the challenges with the traditional method of taking babies to the MRI system in the Radiology department?

A. I think one of the challenges for the traditional 3T, 1.5T, large scanners is that there’s many different sequences that need to be interpreted, and so it takes a lot more time to go through those sequences.

There’s also, again, the booking of the tests and the challenges with having multiple different patient ages and volumes coming through. The time for the neuroradiologists to interpret a scan done on a dedicated neonatal MRI system is much less than the time it takes to review and even undertake a scan on traditional MRI scanners.

In terms of the technologists, I think the platform of a neonatal point-of-care MRI system, from what I’ve seen, is very user friendly. The ability for the technologist to be right in the room with the patient while the scan is taking place is a huge advantage.

And certainly that’s also an advantage for nursing and the team who are bringing the patient to the scanner. You can be right in the room with the patient the whole time. The proximity to the patient is much closer.

And the ability to be able to act if something goes wrong, the time is reduced for that. And you don’t have to worry about the magnetic field, which is another big disadvantage with the large scanners.

Q. You mentioned the 3T and the additional sequences to review. Can you elaborate about the 1T point-of-care scanner versus a 3T scanner and your thoughts around the ability to get the imagery needed?

A. With the point-of-care MRI unit for neonatal care, all of the key sequences are available. So T1, T2, the DWI sequences – we can look on the coronal plane, the axial plane and the sagittal plane. So, all three planes are available.

There is also a SWI sequence that has the ability to look for blood products that may be present. All of the key imaging sequences necessary to evaluate neonatal neurological status are available with a point-of-care system.

Really, when we think about the patients that we would traditionally scan in the NICU, those are the mainstay sequences that we would use. So, 90% of children or babies who require an MRI would be well served with the point-of-care MRI systems now available.

And certainly if we did see anything that was more unusual, we could still always go to a larger scanner that has more detailed pictures and different sequences with smaller cuts and the ability to look for metabolites in the brain with spectroscopy and those kind of things. But 90% of what we would traditionally need with the sequences are available in new systems.

Q. You made an excellent point of going from 1T and being able to get all of the sequences, but have the opportunity to go up to a 3T, if needed. If someone asked, "Well, why wouldn't I just go to the 3T first?" What would be your response to that?

A. Well, certainly again, the reason to utilize a point-of-care MRI system without leaving the NICU, , as the first line test, is because of the ability to scan quickly, the ease of use, and the ability to be able to go there more than once on sequential days if needed. Plus, the ability to accomplish all that without ever transporting the infant.

And you don’t have to wait in line, basically, for a time to take the patient to MRI. Safety is really the main issue. It’s the safety and the time outside of the unit for these tiny fragile babies that is the big impact.

And certainly if we did see anything that was more unusual, we could still always go to a larger scanner that has more detailed pictures and different sequences with smaller cuts and the ability to look for metabolites in the brain with spectroscopy and those kind of things. But 90% of what we would traditionally need with the sequences are available in new systems.

Q. Are there any additional thoughts that you would like to share?

A.  As I said in the beginning, MRI is really a mainstay of treatment in neonatal neurocritical care and the ability to assess brain injury, and the impact of the neonatal point-of-care MRI is really threefold.

One is that you don’t need to move the patient as far, and there’s no competition with the other patient populations. It’s specific to the needs, and schedule, of the neonate.

The second would be the advantage of being able to do imaging serially, one day after another, to follow the evolution of an injury.

And the third thing would be the safety and the fact that there’s no radiation involved. It’s not like a CT scan or an x-ray where there’s radiation involved. So MRI is definitely very advantageous for those reasons.

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Aspect Imaging is a global leader in the design and development of compact, MR imaging systems for Pre-Clinical and Medical applications. Through state-of-the-art technology, Aspect Imaging offers innovative point-of-care MRI solutions, including the Embrace® Neonatal MRI System, which is designed to facilitate enhanced patient-centered diagnostic capabilities inside the NICU. 

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