eHEALTH-June-2011-[8-10]-Imaging Beyond Imagination

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imaging Beyond Imagination Technological advancements and growing clinical applications have made MRI one of the most sought after imaging techniques

By Divya Chawla

T

he imaging industry is at the cusp of a revolutionary growth owing to constant evolution of technology.

The incessant growth has been a result of a combination of factors, which include the vital role of imaging in diagnosis and therapy and growing information technology applications,

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among others. Newer clinical applications continue to provide the requisite fodder for maintaining this dynamic growth. Since its inception in the 1970s, magnetic resonance imaging (MRI) has become one of the largest and most crucial segments of the imaging equipment market. Originally developed for imaging of the central nervous system, the scope of MRI applications has now expand-

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ed to include imaging of the entire human body. Dr H Satishchandra, Professor and Head, Department of Radiodiagnosis and Imaging, Bangalore Medical College and Research Institute, Medical Superintendent, Bowring and Lady Curzon Hospital says, “The prime concern of diagnostic imaging is to direct appropriate treatment at the earliest.

MRI systems that improve image quality and

cover story imaging speed can ensure this, at the same time it is pertinent for the systems to be patient friendly.”

The non-invasive MRI technique is capable of generating elaborate images of human body’s internal areas, through the use of radio waves and magnetic field. Advancements in technology have led to development of MRI systems that are used for effective diagnosis in the fields of cancer screening, neurosurgery planning, angioplasty and breast screening. Dr H Satishchandra says, “MRI has evolved from an unfavourable beginning in 1970s to an unrivalled imaging modality today. Apart from providing an excellent anantomical display in any plane with no radiation risk to the patient it has made strong inroads into noninvasive therapy.”

Surplus clinical applications The growing clinical applications of MRI have been a result of continuous advancements in technology and increasing Tesla strengths. The enormous market growth in this segment has also been a result of the increased clinical applications.Traditional bone scanning techniques are increasingly being replaced by whole body MR techniques that have splurged in the market.

With reduced scanning times, whole body MR is a promising clinical application. The preferred machine for this application is the latest 3 Tesla equipment that provide scope for parallel imaging. MRI combined with Positron Emission Tomography (PET) is used in Functional MRI (fMRI), which is currently one of the most popular MRI techniques. The structural image is provided by

The global MRI equipment market is expected to reach US $7.4 billion by the year 2015, as per reports. Although, the market was stung by recession in the past years, yet it has flung back and achieved a good growth rate the MRI and functional image is provided by the PET, which results in superior imaging, particularly useful for brain neurological disorders. Functional MRI is a very powerful method to map brain functions with relatively high spatial and temporal resolution.

“With the advent of new and advanced applications like fMRI, MR Elastography and MRgFUS, MRI has revolutionised medical care” Dr H Satishchandra Professor and Head, Department of Radiodiagnosis and Imaging Bangalore Medical College and Research Institute & Medical Superintendent, Bowring and Lady Curzon Hospital

Experts suggest that the clear pictures of the brainstem and posterior brain, provided by fMRI, are difficult to view through CT scan, which makes it a better imaging modality as compared to the CT, for the brain.

There is also a growing implementation of MRI in interventional radiology applications. MRI techniques are being used for image-guided minimally invasive procedures, such as biopsies. Cardiac and breast procedures are now mostly performed through MRI. MRI can distinguish tumours or other lesions from normal tissues and this has increased its popularity for intraoperative MRI for brain or spine surgeries. The American Cancer Society (ACS) approved the use of MRI to screen women at high risk of breast cancer. MRI has the ability to detect small abnormal breast lesions, which makes it an effective tool for detecting breast

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“From a buyer’s perspective, it is essential to understand the clinical application of various MRI sequences, as additional software into the machine is an additional cost to the buyer” Dr TBS Buxi Head – Department of CT Scan and MRI, Sir Ganga Ram Hospital

tumours. With advancement in cardiovascular magnetic resonance imaging (CMRI) has over the past few years, MRI appears to be a more sensitive test in detecting the most common form of stroke as well as for diagnosing haemorrhagic strokes. MRI for cardiovascular imaging breast imaging and so on are emerging as the most promising newer applications of MRI. Dr TBS Buxi, Head – Department of CT Scan and MRI, Sir Ganga Ram Hospital says, “The endeavor of almost all companies manufacturing MRI equipment has enhanced from routine anatomical body imaging to the physiological and metabolic aspects of the morbid pathology.

The ushering of higher gradient field strength, adaptive coils with more number of channels, shorter sequences and digital transfer of data has resulted in super class images. Spectroscopy, tractography, functional imaging, diffusion-perfusion imaging not only help in early diagnosis but in many instances in characterization of disease processes and surgical planning. High strength MR machines with a number of newer sequences are now available in the market.”

He further adds, “All of these sequences are not provided free of cost with the magnet, irrespective of the Tesla strength. Many a sequences which sound very lucrative are not really used in our daily practice. It is advisable to visit multiple centers using these sequences to understand the utility and functionality of each and then decide if it is of added advantage in the vendor’s setup.”

Redefined market trends The global MRI equipment market is expected to reach US $7.4 billion by the year

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2015, as per reports. Although, the market was stung by recession in the past years, yet it has flung back and achieved a good growth rate. The current growth can be attributed to continuous improvements in image quality and development of newer techniques, espe-

“Siemens Healthcare offers a wide range of products from Permanent Magnet 0.35 Tesla to 3 Tesla. Our USP is in unique applications like SWI, SPACE, GRAPPA and Angio studies with surface coils. Tim technology through, which one can enhance patient comfort and productivity is one of our major USP” Umesh Kumar KN Business Head – MRI Siemens Healthcare

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cially for imaging specific portions of brain’s complex structures. Growth is also being propelled by the widening scope of clinical applications, including promising applications such as MRI for breast imaging and cardiovascular imaging.

The highly popular applications of MRI such as abdomen imaging and musculoskeletal imaging are currently gaining momentum. Sharing the Indian MRI market statistics, Umesh Kumar KN, Business Head – MRI, Siemens Healthcare, says, “MRI Market in India is growing fast at 13 -14 percent year on year. One of the reasons could be that the ratio between the population and MR installations is one of the lowest compared to the standard ratio in the world. However at the same time, increasing awareness towards healthcare is leading to the increase of awareness in the field of MRI.” He adds, “The current trend is upbeat and year on year the results are surpassing our expectations. The future is looking optimistic with the revolutionary MR PET being introduced in the industry, which is expected to take the MR market to a different level.”

The newer 3T MRI systems have been gaining acceptance owing to the various advantages they offer over the conventional 1.5T systems. With 3T MRI minutest structures such as blood vessels as small as 200-300 micron can be viewed. 3T MRI systems have almost 3-4 times higher signal-to-noise ratio (SNR) because of which, they can precisely localise areas of activation, thus enabling accurate mapping of brain function. It also offers much faster and higher quality and resolution of spectroscopy. As per the latest trend, many 1.5T replacement systems are expected to shift to 3T systems.

Country trends The United States, Japan, and Europe collectively account for a major share of the global MRI market, as stated per reports.

The impact of the global economic meltdown on BRIC countries (Brazil, Russia, India & China) has been limited, allowing governments to continue focusing on the implementation of long-term initiatives aimed at improving healthcare infrastructure. The Indian market, hence, has been experiencing significant growth. The large