Of all the imaging technologies that GE Healthcare is involved with, magnetic resonance (MR) is still one of the youngest. It may also be the most exciting. To get an update about GE’s MR division, we spoke with Jim Davis, vice president and general manager for global MR at GE Healthcare, who provides an overview of the applications and opportunities that this imaging modality offers, upcoming product objectives, and market opportunities for MR around the world.
What is so special about magnetic resonance as an imaging technology?
MR is one of the most powerful diagnostic imaging tools today. In terms of imaging soft tissues — brain, spine, liver, kidneys, bowels — it provides one of best “soft tissue” contrast of any imaging modality. It also has the benefit of using non-ionizing radiation. This is important for people who are likely to be imaged multiple times, as may be the case in oncology cases and pediatric cases. For people who are going to have to have numerous images taken over a number of years, it’s a very effective modality without the risks of ionizing radiation.
In what ways is MR evolving?
You have to remember that MR is really only 25 to 30 years old, and the clinical applications just continue to expand. While MR has long been known for brain, spine and joint imaging, it is moving into other areas including breast imaging, prostate imaging, female pelvic imaging and cardiac imaging. The wonderful thing about MR is that it is anatomical, functional and increasingly metabolic. By that I mean, with MR I can get anatomical information, I can see how organs are functioning in real time and I can look at the metabolic expression of disease.
This versatility is pushing MR into a first-line-of-defense imaging modality. Typically, X-ray or ultrasound are what doctors use first to understand what is going on with a patient. When more interrogation is needed, that's when they move to MR. But increasingly MR is being used from the outset, and breast imaging is a good example of that. Mammography is the standard but, particularly for women with a genetic predisposition, MR is increasingly being used very early.
What has GE Healthcare been doing to improve the experience a patient has when undergoing MRI?
This has been a very big driver of innovation for us. One out of 25 patients cannot physically fit into the older 60 cm bore systems, and statistics also tell us that three to four out of every 10 patients have a difficult time remaining comfortable in a smaller-bore MR scanner because they feel confined and claustrophobic. We now offer a 70 cm 1.5T system that is both wider and shorter than existing systems, giving patients more room and greater comfort.
Another challenge from a patient perspective is the noise created by the scanner, which can be scary to people and exacerbate their sense of claustrophobia. The noise, due to the gradients turning on and off, is a necessary part of the scanning function, but we’re working on a solution that could drastically cut the noise level.
We’re working hard to offer the right-sized scanner for the right anatomy. We have a scanner today for knees, hands, fingers, ankles and wrist. But what about head, breast and prostate — why do you have to get into a full-size scanner to get those parts of the body imaged? So we're hard at work to develop and design the next generation of scanners appropriate to specific parts of the anatomy, and this is a fundamental move that differentiates us from our competitors. Our acquisition of ONI was a deliberate choice as we move in this direction.
Exam time is another issue. The time required for an MR exam is considerably longer than for X-ray or CT, and this can compound patient discomfort. We’re looking into ways to speed the exam, which would also have huge clinical advantages.
What innovations are being driven by the clinical side of things?
Relative to other scanning modalities, MR tends to be more complicated. You can’t expect a technologist who's only done CT or X-ray to step in front of an MR scanner and start using it. It has more variables to adjust for optimal image quality. We're trying to radically simplify the MR system so technologists anywhere in the world can operate them.
We’re also working to make MR a more quantitative modality. Today most imaging produces a cross-section of the body and the radiologist interprets it. We want to be able to deliver physiological data. One example is what we call MR Elastography, which is a noninvasive way of determining fibrosis in the liver. It's an application available now on our Optima MR450w scanner. We are also working on fat fraction techniques…both organ and whole body based.
What is GE Healthcare doing to make MR technology more accessible around the world?
The growing adoption of MR worldwide is phenomenal. As healthcare develops in a country, there is a typical progression in imaging adoption from X-ray to ultrasound to computed tomography (CT) and eventually to MR and PET-CT. In the U.S., the average number of MR scanners per million people is about 25. In Europe, it's on the order of 12. In Germany it's about 20, while Romania and Russia are significantly lower. In China and India, the number of MR scanners is less than one per million people. So that’s indicative of the huge need, and business potential, to serve more people with MR in developing regions.
We’ve developed our MR 355 and MR 360 Brivo* high-quality 1.5T scanners with emerging markets specifically in mind. And with the specialty scanner, we can image the same anatomy in an appropriate size scanner at one-third the price of a whole-body scan, with no compromise in image quality. In fact, image quality is better, and patient comfort is much greater.
RSNA is a big trade show for GE Healthcare, can you give us any hints about what you'll be launching in Chicago in November?
Well there are a number of themes that you can expect to hear more about. You'll see a continued focus on the patient experience, as we work to make all scanners at all field strengths more patient-centric. We’re continuing to extend the wide bore concept to higher field strengths. You’ll see how we’re improving the productivity of the MR exam through new coil solutions and setups, as well as applications that drive faster MR exams and are aimed at expanding the clinical utility of MRI. These are new body applications and neurological applications that we'll launch to our installed base of customers, enhancing the productivity of systems that have been purchased in the past.
What are the aspects of your job that truly motivate you?
Two things. First, it’s about enabling the earlier detection of disease, and moving MR imaging capabilities from functional to anatomical and metabolic is certainly going to allow us to detect disease at an earlier state, and get people into treatment earlier. And if you think of the impact this can make for people with breast or prostate cancer alone, it is incredibly motivating.
And the second piece is about bringing the benefits of MR to emerging markets where healthcare systems are still growing and developing. Large swathes of Southeast Asia, China, India, Latin America and Indonesia don't have access to MR. In fact, 65-70 percent of the world population does not have access to this powerful machine.
* The Optima MR360 and Brivo MR355 systems are not approved or cleared by the U.S. Food and Drug Administration (FDA) and are not available in USA.