Abbreviated Magnetic Resonance Imaging Protocols in the Abdomen and Pelvis

Factors affecting MRI scanner efficiency in an academic center

PURPOSE

To determine which patient characteristics influence MRI scan time and how.

METHODS

A database search of outpatient MRI liver examinations on 1.5T and 3T scanners from 1/1/2019 to 4/4/2019 was performed using an in-house developed software tool. Mean and median scan times were calculated. Patients who had difficulty following breathing instructions or completing breath-hold sequences were identified. Twenty-one additional patient characteristics were obtained from an Electronic Medical Record (EMR) search.

RESULTS

Scan times were significantly increased for patients with breath-holding issues during the exam (N = 43, median = 23.98 min) versus not (N = 179, median = 17.5 min, p < 0.001). Among patients who had difficulty following breathing instructions/completing breath-hold sequences, a significant number were non-native English speakers (23/43, 53%) compared to those whose first language was English (48/179, 27%, p < 0.001). Breath-holding issues were also significantly more frequent for patients requiring a translator during the exam (15/43, 35%) versus those who did not (24/179, 13%, p < 0.001). No other patient characteristics showed a significance difference between those with breathing issues and those without. Patient characteristics that caused a significant number of scan times to be one standard deviation or more above the median were as follows: Breath-holding issues during exam (21/43 ≥ one SD above, 51%, versus 22/189 < one SD above, 12%, p < 0.001); and first language not English (16/71 ≥ one SD above, 23%, versus 55/189 < one SD above, 29%, p = 0.03).

CONCLUSION

The ability to follow breathing instructions and complete breath-hold sequences had a significant impact on patient scan time. Patients who were not native English speakers had more frequent breathing issues during scans and significantly longer scans times compared native English speakers.

Financial and medicolegal implications of focused/fast abdominopelvic MRI exams

PURPOSE

Abbreviated MRI offers significant advantages in terms of MRI throughput, patient tolerance and expediency, and is being utilized for a variety of abdominopelvic imaging applications. However questions abound with respect to financial and medicolegal treatment of these relatively new protocols.

METHODS

A review of the relevant literature was performed.

RESULTS

There is no Current Procedural Terminology code for a "limited" MRI study, but it may not be appropriate to bill an abbreviated study the same as a more comprehensive study. With respect to medicolegal concerns, the risk of liability when missing or misinterpreting medically significant findings due to use of an abbreviated scan will turn on whether abbreviated MRI has become the standard of care.

CONCLUSION

In light of these ambiguities, it would behoove abdominopelvic imagers to advocate for their professional and subspecialty organizations to issue practice parameters/guidelines with respect to the utilization of abbreviated MRI protocols, and for the subspecialty to bill these abbreviated scans at objectively reasonable rates.