Internet supports remote MR scanning for difficult cases

Demanding studies produce better results if the MR scanner is run remotely by an expert instead of locally by someone with average skills, according to the findings of a clinical study slated for publication in the November issue of the journal Radiology.

"Some patients require specialized scans that not all of our technologists are familiar with, so we implemented a software program that enables us to run the MRI machine from a remote location," said Dr. J. Paul Finn, lead author and chief of diagnostic cardiovascular imaging at the David Geffen School of Medicine at the University of California at Los Angeles. "A technologist who is skilled at performing that particular scan can log on from a personal computer and perform the exam via remote control."

The software is Expert-i, developed by Siemens Medical Solutions and unveiled at the 2005 RSNA meeting (DI SCAN, 1/11/06, "MR vendors reach out with new applications, functions").

At this year's meeting, the company and a principal luminary of its Expert-i technology, UCLA researcher Finn, will have the clinical goods to go with it.

In a study conducted at UCLA, 12 cardiac procedures (cardiac cine and myocardial delayed enhancement) and 30 MR angiograms were performed at 1.5T by an operator accessing the scanner remotely using a personal computer. Results were assessed for overall image quality as well as motion artifact, and compared with matched control studies performed conventionally by local technologists.

Image quality was rated as excellent in 90% (38 of 42) of the remotely operated exams versus 60% (25 of 42) of the control group procedures under local control. Scores for motion artifact were not significantly different.

In the time since Radiology accepted the study results for publication, another 50 patients have been scanned with the remote technique with similarly positive results, Finn said.

In the study, the UCLA researchers concluded that interactive MR imaging was successfully implemented with remote scanning in complex cardiovascular cases and that the diagnostic quality of images was superior to that of images obtained locally. The difference was the interactivity and expert guidance provided during the remote exams, a capability made possible by the password-protected online software.

As with many institutions, onsite staff at UCLA may have limited experience in performing specialized cardiac or vascular scans. The results of this study indicate that such shortcomings can be resolved by providing specialized skills remotely, Finn said.

Although the operator's skills are the key to successful exams, they cannot be performed without onsite help. While an expert was at the scanner controls, an onsite technologist gave the patient instructions, monitored patient safety, and administered intravenous contrast material, when necessary.

The tests performed in the UCLA study involved some of the most demanding MR scans encountered at a hospital, according to Finn, including scans of pediatric patients with congenital cardiovascular disorders. The rationale was that the patients undergoing these exams are the ones for whom specialized assistance might be needed most.

Because the types of diagnostic scans involved in the UCLA study are among the most complex currently undertaken, it seems reasonable to suggest that the results can be generalized to other types of studies, Finn said. The approach might also be applied outside MR.

He suggests that remote control could be applied to CT, particularly in an emergency setting, such as a natural disaster or on the battlefield. Such events may overwhelm local resources, and may occur where technologists trained in specialized imaging techniques are be hard to find.

"At UCLA, we have already established interstate and transatlantic remote-control connectivity (for MR), and the initial results are very promising," Finn said. "As the speed and reliability of the Internet increases, it seems inevitable that distance will provide no barrier to the global application of this technology."