Despite Economic & Imaging Slowdowns, Niche MRI Demand Remains
Faulkner-Sagoff Breast Center in Boston images high-risk breast cancer patients using a dedicated breast MRI from Aurora Imaging Technology.
We see it everywhere—news about slowdowns in imaging equipment purchases, reductions in reimbursement and the overall poor economic climate. But the demand is steady for breast and cardiac MR, and many facilities across the United States are seeing minimal impact on purchasing needs in the desire to provide leading-edge, quality care.

It’s a fact—the medical imaging community is still feeling ripple effects from the Deficit Reduction Act (DRA) of 2005. IMV Medical Information Division reported last year that MRI procedure growth in the United States has slowed, to approximately a 3 percent annual growth rate, compared to the beginning of the decade. In 2007, an estimated 27.5 million procedures were performed within about 7,200 sites, compared to 24.2 million in 2003, due in part to pre-certification requirements by payors and the maturity of the MRI market.

However, new and niche studies are still a key growth area within MRI—approximately 20 percent of facilities planning an MRI purchase over the next few years are planning to purchase systems as replacement or additional units for their departments (according to IMV)—a fact supported by Centennial Medical Center in Nashville, Tenn., who purchased an additional MRI scanner in December 2008 to better position itself to expand its MRI service line.

Expanding service lines

At the end of 2008, after six to eight months of waiting and planning, Centennial Medical Center in Nashville, Tenn., opened its Christmas gift—a Magnetom Espree 1.5T open-bore MRI system from Siemens Healthcare. The 665-bed facility, which does about 140,000 imaging exams annually, had two specific goals in mind when considering adding an MRI to its imaging armamentarium: one was its desire to open a new cardiac MRI service line and the other was to offer its patient base the option of an open-bore scanner. Siemens’ Espree offered them one scanner that could meet both needs.

Many might question the business sense behind expanding a service line in light of a declining economic climate, however Kim Duncan, RBS, RT (R), says that the decision was driven by demand. “Every decision has an impact in today’s economic climate and while our push was to branch out and offer a new service, we made sure we had the demand to back it up,” Duncan says. Aside from the demand for cardiac MR angiography (MRA), the facility was getting high demand for an open bore, which was not available in its inpatient division.  They were approached by one of their cardiology groups that said the patient base was there—they just had to supply the technology. Duncan says they analyzed the group’s patient volume, the need for that service in their area as well as the reimbursement for such services prior to committing to a new purchase.

Now, Centennial is the only area hospital using an open MRI of this kind on both an inpatient and outpatient basis. The new scanner can accommodate patients weighing up to 550 pounds, and with a 2.3-foot diameter bore, it minimizes the feelings of confinement and claustrophobia for most patients.

While exam growth is still in its infancy for cardiac MRAs—they are doing approximately three to five about three days per week—the expectation is high for the need for studies to extend beyond the cardiology group to other physicians, says Kay Lynn, RT, (R)(M), manager of MR and CT. Additionally, since it is not a dedicated cardiac MR scanner, volume has picked up in other areas for patients who require the open-bore design. In one instance, it eliminated the need and cost for the presence of an anesthesiologist for a patient who had suffered caustrophobia in the past who was able to be scanned without sedation.

Although the system is not dedicated for cardiac studies, there are dedicated time slots for cardiac MRA put on the schedule each week, and for any bariatric patient or patient who would benefit from the open bore, he or she is scheduled on that scanner. “We work closely with the scheduling department to minimize the potential for bottlenecks,” Duncan says, who adds that report turn-around time at Centennial—from sign-in to signed report—is between two to four hours about 75 percent of the time.

Duncan and Lynn say that Centennial, which operates in the competitive Nashville market, is always looking toward the future. One avenue they are evaluating is breast MRI, which Duncan sees as a key growth area. Even though breast MRI accounted for only 2 percent of MRI procedures in 2007, the number of MRI breast imaging studies has doubled since 2003—from 314,000 to 645,000 procedures, according to IMV.

High volume, targeted breast imaging

Faulkner-Sagoff Breast Center in Boston can certainly attest to the growth of breast MRI. The high-volume breast imaging center, which completes between 40,000 and 50,000 mammograms each year, is booked 14 months in advance for exams, and averages about 350 breast MRI studies per month. Patients are typically booked for their next visit within an hour of walking in the door. Medical oncologists at high-risk clinics such as the one at Dana Farber Cancer Institute send high-risk patients that have either an abnormal BRCA1 or abnormal BRCA2 gene for breast MRI screening; almost 75 percent of breast MRIs are done on high-risk patients at Faulkner-Sagoff.

The center has a dedicated breast MRI scanner from Aurora Imaging Technology housed on the first floor. Screening patients are on the second floor and the third floor is for diagnostic work. That amounts to five radiologists on site at all times, says Director Elsie Levin, MD. Two radiologists do screening, two are doing diagnostic work and one works on the diagnostic floor dealing with the overflow and reading breast MRIs. “I like to call it controlled chaos here,” Levin says.

If an imaging center is only doing breast imaging, it makes sense to have something designed specifically for that area—the imaging sweet spot on the Aurora scanner is shifted forward down to where the breasts are. “You can drive a Lexus or an Acura. They will both get you where you need to go, only the ride might be a little more comfortable in one,” Levin adds.

Aside from the technical advantages of having a system dedicated to one body part, it enables more control over the magnet. “[As a dedicated breast imaging center,] we are not competing with other patients for heads and knees and spines, which helps to alleviate anxiety for the patient, especially one newly diagnosed with cancer,” she says.

Patient-centered care extends beyond the exam room, too. While Levin says the center hasn’t felt the impact of the economic crunch per se, it recognizes that its patients might. To that end, a group that does fundraising for the center has created a breast access fund to raise money to cover patients who are un-insured or underinsured—something that is prevalent across Massachusetts.

“As with anything in medicine, it is the service you provide,” Levin adds. As important as it is to have good equipment, it is even more important to have radiologists ready to provide the service. “Ideally, breast MRI is best put in the hands of breast imagers who can correlate MR findings with mammo and ultrasound to benefit the patient.”