Expanded Service Portfolio at Canadian Magnetic Imaging:
Litigation and private patients can now visit CMI’s new Ultrasound Clinic for both diagnostic and therapeutic services. CMI’s expanded diagnostic imaging portfolio now includes therapeutic imaging, pain management, and pain injections, with the same commitment to the highest level of imaging services, professionalism, and sophisticated technology that CMI has always provided. The new CMI Ultrasound Clinic proudly continues its existing relationship with its specialized radiologists, who are all based at a peer-reviewed, teaching hospital.
When first-line therapies fail to provide adequate symptom relief, ultrasound-guided therapeutic injections may be used in an interventional capacity to manage pain in inflammatory and degenerative joint conditions.
Injection of medication directly into the joint (or the soft tissue next to the joint) can reduce inflammation and provide immediate and/or lasting pain relief. Introducing ultrasound technology to these kind of therapies allows for the precise placement of injected medicines into specific joint and bursal spaces in areas of the body such as knees, shoulders, and hips. As medication is injected, the radiologist can see exactly where it is being distributed, ensuring that the local anaesthetic (numbing medication) or steroids (anti-inflammatory medications) are directed to their target correctly.
In addition, effective guided interventions can be performed on tendons, plantar fascia and entheses (where the tendon joins the bone).
For clients who are unable to tolerate an MRI scan (pacemaker, claustrophobia, cochlear and other implants) or with metalware distorting the MRI field of view, diagnostic ultrasound may provide excellent visualization. It’s been shown on sites like www.NervePainGuide.org that, patients that have joint issues with specific movements can be dynamically assessed by ultrasound. This can sometimes be much more preferable that the alternatives.
Personal Injury Claims
In the context of a personal injury claim, therapeutic ultrasound provides the potential for pain relief to allow your client to get back to work, shorten wage loss, and get on with life. It will also provide you with objective assessment relating to pain management and future course of care, information to help determine quantum appropriate for your case. Further, all procedures qualify as treatment, so the cost can be recovered from the insurer as a Special Damage.
The specific musculoskeletal interventions performed at CMI include all ganglions and joint effusion aspiration and injections, diagnostic blocks and steroid injections, botulinum toxin and hyaluronic acid (symvisc, neovisc, etc.) injections. A more exhaustive list of specific procedures can be found on CMI’s Ultrasound-Therapeutic webpage.
Expert Practitioners Available for Legal Proceedings
All diagnostic and interventional procedures are performed and interpreted by staff radiologists subspecializing in musculoskeletal radiology at St. Paul’s Hospital in Vancouver. The musculoskeletal radiologist performing the ultrasound examination will be able to correlate the real-time imaging results with the site and characteristics of your client’s pain.
Other facilities may offer similar services, but at CMI they are performed by an expert radiologist who will provide a written report. CMI’s specialists are comfortable appearing and testifying in court and are readily accessible leading up to trial.
CMI’s radiologist will perform and discuss the results with your client at the time of their procedure. A more detailed written report will then be produced and sent to your office and the referring physician within 2–3 business days of the exam.
Therapeutic ultrasound has the potential to offer clarity with respect to the nature of your client’s injuries and to help determine quantum.
In the present clinical environment a new wave of advancements is creating a clear divide between MRI providers.
A report, published in August 2012 by IMV Medical Information Division, surveyed MRI/radiology department administrators and MRI lead technologists from 408 hospital-based and non-hospital imaging sites across the U.S from May to June 2012.
This market outlook report analyzed the challenges and opportunities MR providers are facing in the coming years and provided opinions related to future MRI trends.
The report concluded that there is a motivation to stay current with the advances in MRI technology and two clear driving forces were identified: Wide-bore technology (70 cm bore and greater) and high-field magnet strength (greater than 1.0 Tesla).
The IMV study found that high-field, 1.5 Tesla MRI remains the modality’s mainstay platform and that 1.5 Tesla MRI represents 70% of the installed base and 70% of new installations.
Interestingly, the report found that there is minimal demand by providers for 3 Tesla MRI due its limitations arising from the lack of clinical experience with the 3 Tesla platforms.
The report also makes clear that the demand for low-field MRI has virtually disappeared as it represents just 10% of the installed base and less than 1% of planned purchases in 2012.
At CMI, we have stayed current with imaging advancements. This report confirms that CMI’s high-field, wide bore 70cm 1.5 Tesla magnet is the magnet of choice for clinics wishing the latest in MRI technology.
Not all MRI’s are created equal. Important factors to consider when choosing where to have your MRI include the strength of the facility’s magnet, the protocols which they offer, whether they have invested in dedicated coils specific to the body part being imaged, as well as the overall design of the magnet. Dr. Jason Clement reviews these considerations in the following video.
When seeking the services of a MRI facility you have choices. Whether you are considering being imaged at CMI or another clinic, there are important questions to ask to ensure that you are receiving the very best that MRI imaging has to offer.
Within the imaging community, there is considerable variability with respect to technology, the protocols and sequences that are used to obtain your images and perhaps most importantly, the technicians and radiologists who administer, read and report your images.
Other considerations include the quality of the service that you receive and the manner in which your findings are reported to you.
You may find the answers to these questions helpful in searching for an imaging facility that best suits your needs.
What type of technology/equipment does the facility use?
The type of MRI scanner used will directly impact the quality of image being produced and is one of the critical components of image quality. If you wish the best images available it is imperative that the technology being utilized is “high-field”. A high-field scanner has the ability to discern anomalies in far greater detail than low-field/extremity magnets and is particularly important when imaging the brain and core of the body. True high-field MRI machines are those with a magnetic field of 1.5 Tesla or greater. In addition, as MRI technology changes & advances quickly ask if the machine is more than 5 years old and, if so, ask if it has undergone a major hardware/software upgrade to keep current.
Does the clinic have the right hardware for the scan?
If you need a brain, shoulder, knee, foot, wrist, breast, chest or abdomen scan make sure the clinic has a dedicated coil (a piece of hardware the scanner uses to pick up signal) for that particular area. Some clinics use an all-purpose coil in place of a coil dedicated to the body part and if so that will negatively impact image quality and therefore the diagnostic accuracy of the examination.
What specific protocols will be utilized in your scan?
A high-field MRI scanner can be programmed with hundreds of commands. A protocol is the name for the series of commands and sequences a clinic programs into their machine to scan different areas of the body. These protocols can differ significantly between clinics and can materially affect the information obtained and therefore diagnostic confidence of your scan. Take for example the MRI evaluation of post traumatic changes in the brain. In the peer reviewed literature it has been established that particular sequences (2mm Gradient T2* & SWI) are most sensitive for the detection of small hemorrhages that can occur in trauma. Yet most public and private facilities do not include these sequences limiting the sensitivity of the examination. The same protocol issues are true for many other parts of the body.
Are the Radiologists who read the scans hospital-based & specialized in the area of the body that they are reading?
The importance of the qualifications and the ability of the radiologist who reads the scans cannot be overstated. Radiologists who are hospital-based or directly affiliated with a teaching-based hospital have extensive experience garnered through the thousands of scans they have reviewed in their time working at the hospital. In Canada, radiologists who have not spent a significant time on staff at a hospital reading MRI will not have had the same opportunity to gain the requisite experience.
Another critical consideration is whether the radiologist reading your scan is specialized in reading images in that area of the body. Due to the broad scope of radiology many radiologists have specialized training or experience in particular body parts. For example, a radiologist may be primarily focused on the interpretation of neuroimaging examinations but not be involved in the interpretation of chest, abdominal or pelvic imaging. Increased experience and expertise in a particular area will improve the accuracy of the reporting radiologist in this particular area.
Is the scanner being used an “open or wide- bore” design?
Patients now have the opportunity to seek out the new generation “open or wide-bore” designed scanners that, for example, CMI utilizes. These scanners provide approximately twice the room in the magnet than traditional high-field scanners and because of their shorter length of tunnel (4ft as opposed to 8ft) more than 60% of exams are performed with the patient’s head outside of the magnet. Without sacrificing anything in image quality, open bore scanners significantly reduce feelings of anxiety or claustrophobia. These wide-bore scanners can comfortably accommodate patients up to 550 lbs as opposed to the weight limit of 300 lbs in traditional magnets.
Open-bore scanners should not be confused with “Open” scanners which are typically open on 3 sides and are low field magnets (1.0 Tesla or less) which, though comfortable, provide inferior image quality.
How does the clinic report its findings?
It is important for a MRI facility to work in partnership with your referring physician. The communication between the referring physician and the radiologist should be open and readily accessible. Your referring physician has the most familiarity with your personal and medical history, and is the best person to report back to you the results of your imaging. In this way, you and your physician will have the opportunity to review your findings together, discuss how the results may be related to your medical history and discuss potential treatment options with you.
In the interest of speed of reporting, some clinics offer the radiologist to review your results with you immediately following your scan. While a radiologist is likely able to review your results (the radiologist on site may not be the one who specializes in the area you had scanned), they lack the critical personal and medical information specific to each patient (such as your relevant history and/or previous images and tests) to be able to properly discuss your results.
A respect for continuity of care and partnership with the referring physician are important factors to consider when choosing a clinic.