Lovelace Women’s Hospital is New Mexico’s first and only hospital dedicated to women’s health. It offers a nationally accredited Breast Care Center, providing the latest in 3D mammography and surgical procedures. As a breast imaging leader in the region, the facility performs a high volume of breast imaging and strives to offer the latest technology, supporting a high level of patient care.
An upgrade in resolution that saved money
The MR 30 for SIGNA™ software upgrade allowed the facility to update its standard protocols with new sequences, including LAVA Flex, a 3D FSPGR imaging technique that generates water only, fat only, in-phase and out-of-phase echoes in one acquisition with a single breath-hold. “With the Flex sequences, we can get both fat and water separation at the same time. So, it’s like getting a two-for-one deal where you get double the number of images for the same scan time,” says Rita House, lead MR technologist at Lovelace Women’s Hospital.
The SIGNA™ Artist Evo is the first and only upgrade on the market that widens the bore on legacy 1.5T MR systems to 70 cm. It also gives Lovelace the ability to use the lightweight, flexible and blanket-like AIR™ Coils. AIR™ Recon DL and the AIR™ Coils work together to improve image quality over the hospital’s previous system, especially in patient populations that have trouble lying still. The shorter scan times on the SIGNA™ Artist Evo reduce this difficulty for both patients and technologists. The facility is also using AIR™ Recon DL 3D, which has further improved lesion visualization and exam speed. With the upgrade, Lovelace Women’s Hospital refined its breast imaging protocol. For example, slice thickness in the VIBRANT sequence was reduced from 2 mm to 1 mm.
“The big thing for me is the significant increase in spatial resolution,” says Anthony Miller, MD, a diagnostic radiologist who specializes in breast imaging. “I think we can characterize lesions much more accurately than before because we can see finer detail, so it makes us more confident in making a diagnosis or ruling out an issue in the breast tissue.”
Dr. Miller also noticed the upgrade and new technologies are increasing his diagnostic confidence, which helps him reduce the number of false positives in these MR examinations with women who are at high risk for breast cancer.
“I’m much more confident that I’m not missing a lesion on MIP images, given the greater resolution. In the past, I might have wondered, ‘is that blood vessel?’ or ‘is that a lymph node?’ or ‘is that really an enhancing mass?’ Now I can better determine what I’m seeing to reduce having to take a second look with ultrasound or additional images,” says Dr. Miller.
Shorter scan times and improved patient comfort
The MR 30 for SIGNA™ software upgrade allowed the facility to update its standard protocols with new sequences, including LAVA Flex, a 3D FSPGR imaging technique that generates water only, fat only, in-phase and out-of-phase echoes in one acquisition with a single breath-hold. “With the Flex sequences, we can get both fat and water separation at the same time. So, it’s like getting a two-for-one deal where you get double the number of images for the same scan time,” says Rita House, lead MR technologist at Lovelace Women’s Hospital.
Figure 1.
A 182 lb woman referred for breast MR follow-up. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. (A) Axial 3D T1, 0.8 x 0.8 x 2 mm, 1:54 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 FLEX, 1 x 1 x 2 mm, 4:18 min.; and (E) 3D VIBRANT FatSat, 0.8 x 0.8 x 1 mm, 2:44 min. with (F) coronal and (G) sagittal reformats. The dynamic sequence was acquired in 7:29 min. for all phases. Total exam time was 8:56 min.
Figure 2.
A 110 lb woman referred for breast MR. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. (A) Axial 3D T1, 0.8 x 0.8 x 2 mm, 1:46 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 FLEX, 1 x 1 x 2 mm, 1:56 min.; and (E-G) 3D VIBRANT FatSat, 0.8 x 0.8 x 1 mm, 6:59 min., 3 phases with delays. Total exam time was 10:41 min.
Figure 3.
A 178 lb woman referred for breast MR follow-up. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. (A) Axial 3D T1, 0.8 x 0.8 x 2 mm, 1:43 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 Flex, 1 x 1 x 2 mm, 4:29 min.; and (E-G) 3D VIBRANT FatSat, 0.8 x 0.8 x 1 mm, 6:48 min., 3 phases with delays. Total exam time was 13:00 min.
Other options such as AIR™ Recon DL PROPELLER, an extension of AIR™ Recon DL to the PROPELLER acquisition technique, simultaneously reduces motion artifacts and image noise in addition to delivering substantial scan time reduction. “There are fewer repeat scans due to patient movement because the PROPELLER image removes that motion,” says House.
The combination of AIR™ Coils and AIR™ Recon DL has also improved exam speed, which has allowed Lovelace to shorten time slots and accommodate more patients. The facility shortened breast scan times to approximately 15 minutes, even for patients with breast implants. “Most of our exams have decreased in scan time and patients are surprised that they are so fast. And that helps them feel a little more relaxed,” says House.
This, in turn, has led to less patient movement because patients have to stay still for a shorter amount of time. “The shorter exams mean our patients are more comfortable for the duration of the exam. In the past, we might have to stop midway and coax the patient through the exam. Now we don’t have to do that because patients are more comfortable,” says House.
The larger bore is another patient satisfier that reduces anxiety and increases compliance during the scan. “We definitely see a difference in our patients. The larger bore makes them feel more comfortable because it’s not as small,” says House.
The facility is using the NeoCoil™ 16-channel Breast Coil for breast MR examinations and biopsies. The coils are lightweight, making it easier for technologists to position patients on the table.
“Our patients are giving us a lot of feedback that it is more comfortable. It’s also easier for the technologist to get patients set up in the coil due to the new design and the ability to lower the table closer to the floor. In our old configuration, our patients had to climb up steps in order to get onto the table,” says House.
They are also using the AIR™ Coils on all musculoskeletal studies, as well as abdominal, pelvic and neuro examinations. With these coils, image quality has improved across the board. “The T2-weighted images are much sharper and the T1 images to evaluate the axilla and chest wall are much better quality than they were before,” says Dr. Miller.
Overall, the new coils are improving patient comfort. “The AIR™ Coils tend to help because patients don’t feel enclosed in a hard coil that limits their mobility. They don’t feel as confined with the flexible coils,” says House.
Figure 4.
A 149 lb woman referred for breast MR follow-up. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. (A) Axial 3D T1, 0.8 x 0.8 x 2 mm, 1:43 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 Flex, 0.9 x 0.9 x 2 mm, 4:08 min.; and (E-G) 3D VIBRANT FatSat, 0.8 x 0.8 x 1 mm, 6:48 min., 3 phases with delays. Total exam time was 12:39 min.
Figure 5.
A 147 lb woman with breast implants referred for breast MR. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. (A) Axial 3D T1, 0.8 x 0.8 x 2 mm, 1:57 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 Flex, 0.9 x 0.9 x 2 mm, 2:10 min.; and (E-G) 3D VIBRANT FatSat, 0.8 x 0.8 x 1 mm, 7:42 min., 3 phases with delays. Total exam time was 11:49 min.
Figure 6.
A 313 lb woman referred for breast MR follow-up. AIR™ Recon DL was used for all 2D, 3D and Flex acquisitions with the 16-channel NeoCoil™ Breast Coil. Although large-sized patients with large breasts will require more scanning time, the exam was still completed in under 20 min. (A) Axial 3D T1, 1.1 x 1.1 x 2 mm, 2:50 min. with (B) coronal and (C) sagittal reformats; (D) axial T2 Flex, 1.1 x 1.1 x 2 mm, 6:29 min.; and (E) 3D VIBRANT FatSat, 1 x 1 x 1 mm, 10:07 min. (3 phases with delays) with (F) coronal and (G) sagittal reformats. Total exam time was 19:26 min.
Building on a strong partnership
The facility’s partnership with GE HealthCare was a deciding factor for the upgrade to the SIGNA™ Artist Evo. “It was important that we stayed with GE HealthCare because all of our techs had been using GE HealthCare exclusively, and they really liked it,” says Sherry Aragon, MBA, CNMT, RT(N), Administrative Director at Lovelace Women’s Hospital.
Upgrading the system also eliminated the learning curve that comes with integrating new technology into the department, while preserving the high level of service Lovelace had come to expect from GE HealthCare. “We have always had excellent service from GE HealthCare. There was a nice team of people who worked really hard on this upgrade, from field service engineers to our regional and local salespeople. It was a huge team approach, so for me it was a big deal that we were able to stick with what we had and still do something new,” adds Aragon.
