In this issue’s lead story “Intentional innovation of a new MR foundation for patients, technologists and our world,” our colleagues share an analogy of a three-legged stool to describe the reality of how engineering must balance the cost, performance and design effort of a final product. Here, we extend that analogy to the radiology department—where patient experience, scan quality and staff burden must also be balanced. We are pleased to share four new technologies‡ that are designed to put the patient at the center of the radiology workflow:
- A new, more comfortable table that will be easier for technologists to manage and move patients on and off.
- Zero-touch physiologic monitoring technologies that are expected to eliminate respiratory bellows and reduce the need for patient breath holds.
- A new intercom system with intelligent noise reduction that will make it easier for the patient to communicate with staff.
- A new head coil that will eliminate the need to change coils mid-exam and makes neuro exams more accessible by supporting entertainment audio to keep patients calm and reduce movement.
Over the past few years, our global MR team has spent thousands of hours building empathy for the pain points and challenges of our patients and users. We then applied intention in defining products to address these challenges and iterated until we found meaningful solutions. We hope that this article gives you a glimpse of our team’s passion for technology, while living our purpose of putting patients first.
In the 40 years since the first SIGNA™ whole-body MR, we have amassed knowledge and insights about how MR is used. But the significant challenges facing healthcare today necessitated we start fresh and reconsider what we thought we knew about MR imaging. To put patients first, we packed our bags and set out to relearn how MR imaging and patient care is done all over the world.
These observational experiences helped us embrace that we aren’t just designing a table or new physiologic gating solution for MR imaging. We are designing an important component for a system that can provide life-saving information on a patient’s condition to clinicians.
Always in motion
We unpacked our notebooks, cameras, pencils and even tape measures when visiting sites to capture as much about the MR experience from both the technologist’s and the patient’s point of view. We quickly appreciated the constant motion of technologists as they changed patients in and out of the MR examination room. Our teams very quickly understood the large number of small technologist movements from bedside to storage area, back to bedside, to sinks, injectors, linen hampers and more. These lessons had a significant impact on our team, particularly those early in their careers.
The illustration in Figure 1 makes clear the high degree of activity and motion required of MR technologists to achieve high-quality exams. These challenges are made more acute when considering many patients have co-morbidities or contraindications like MR Conditional implants that must be managed. We also observed the increasing complexity of MR exams. Difficult procedures like cardiac and whole-body imaging—once the domain of specialty imaging groups—are now entering the mainstream in both inpatient and outpatient imaging centers. These procedures increase the burden on staff, and while many of GE HealthCare’s artificial intelligence (AI) solutions offer the means to mitigate some of these challenges, we quickly concluded that we must intentionally develop software and hardware solutions that address the entirety of the patient experience, staff burden and exam quality. Our teams in the U.S. and China quickly rose to the challenge.
Figure 1.
Based on our team’s observational experience, we mapped the movement of technologists during a common exam (prostate) to best understand their workflow during patient preparation.
One of the next observations was the strong influence of the patient’s behavior on high-quality imaging and the potentially large amount of staff effort expended to mitigate these challenges. A patient who is anxious or uncomfortable tends to move and create artifacts. Very sick patients often cannot complete breath holds needed for the highest quality images. While not groundbreaking observations (we have known both for many years), they did take on greater significance in our design process, where patient experience is of the utmost importance.
The human body is never truly still—whether through the motion of the chest walls during respiration, the pulsatile flow of blood through the major arteries, or even involuntary peristaltic motions of the digestive system. Even the smallest motion can create artifacts in MR images, which may require repeat imaging or loss of diagnostic confidence. Imaging technologies like navigators have been developed to provide tools to mitigate respiratory motion, but these can add significant time required for setup.
A common method to monitor the motion of the chest wall is with devices that sit atop or around the patient’s diaphragm to synchronize the MR to the patient’s breathing. While effective, this requires the technologist to set up the devices prior to imaging and is only used for respiratory motion. To monitor and mitigate pulsatile flow artifacts from the patient’s beating heart, a separate measurement device is placed on the patient’s finger. Both techniques require the staff to carefully place devices on the patient prior to imaging. It’s an uncomfortable process for patients as they are moved and prodded as the technologist tries to find the best placement for the devices. In some cases, the technologist must re-enter the exam room to adjust or otherwise correct the device for proper function. This adds time and burden to already busy staff.
The non-contact respiratory gating feature in the Next Generation MR Platform‡ is designed to measure the respiratory cycle without any external devices, markers or setup from staff members. It will reduce the need for patient breath holds by using a measurement device embedded in the patient table to measure changes in the size and shape of the chest wall. When processed by the MR system, the acquisition can be synchronized to the patient’s respiratory cycle without additional input from the technologist. The Next Generation MR platform uses two sensors to enable feet-first head imaging here as well—a feature our customers have come to expect from SIGNA™ MR.
Our Next Generation MR platform includes technology developed to monitor the patient’s heartbeat and reduce the effect of blood flow on the resulting images. By taking advantage of the sophisticated signal processing technology already within the MR, we added a small signal to allow us to “see” the beating of the heart and enable the system to synchronize with the patient’s heart. We faced an important design choice on how to commercialize our work—to modify the design of our surface coils (a more straightforward solution), or to develop a more complex signal processing method but allow any existing AIR™ Coil to be used. Our SIGNA™ Continuum promise to make technology available to as many customers as possible made our decision easy—we invested greater design effort but avoided the need to redesign our surface coils, which would make this a more exclusive and higher cost technology for our customers.
A customer favorite since 1983
A detachable patient table that can be removed from the magnet room, brought to a patient in a prep room and even removed from the magnet in an emergency presents significant workflow advantages over one that is fixed. But like many problems discussed here, it presents an engineering challenge not easily solved without intentional innovation.
Figure 2.
(A) A prior generation detachable table required foot pedals and manual operation. (B) The Next Generation MR table is intentionally designed to support staff, patients and operations for effortless transfers and patient preparation, improved maneuverability, single-handed controls and autonomous table docking.
SIGNA MR was the first commercially available MR system to use a detachable table—dating back to the SIGNA 1.5T system first launched in 1983 that has been a customer delight ever since. At the time, the table was a patient transport unit—not much more than an MR-compatible gurney that permitted the movement of the patient into the bore of the magnet. Over the years, the utility of these tables has grown significantly. Most notable has been the incorporation of coil connection ports that simplify patient setup when using RF surface coils and the inclusion of a spine (“posterior”) array directly into the table, further reducing the complexity and time required to complete patient setup. Though these features meaningfully improved the technologist and patient experience, they also introduce significant engineering complexity. From an engineer’s perspective, the positioning of RF cabling that enables coil ports at the patient’s side must be carefully managed within the interior structure of the table to prevent heating concerns. For the Next Generation MR Platform, we quite literally started with a blank design, allowing us to intentionally plan a patient table design that meets elevated expectations for patient experience and technologist efficiency.
During our observational research, we carefully studied the movement patterns of patients, technologists, staff members, MR system components such as detachable tables, and also smaller equipment like IV poles, cleaning wipes, blankets, rolled paper and surface coils. We compiled this data and carefully studied the trends before making any design decisions. Using this treasure trove of data gave us actionable insights that enabled us to be even more intentional about the design of the Next Generation MR patient table. These included:
- Supporting patients—including effortless wheelchair transfers, high weight capacity and feet-first whole-body imaging
- Supporting staff—by intentionally improving the maneuverability of the table compared to previous generation tables, and providing single-handed controls and autonomous table docking
- Supporting safe and efficient operations—by supporting patient preparation on multiple tables and an improved intercom to make patient communication fast and simple
Supporting patients
As the world population and life expectancy increase, so too will the frequency of patients using wheelchairs and assistive devices who require MR imaging. This presents an increasing problem for staff, who, depending on the configuration of their MR system, may need to perform one or more patient transfers to safely move the patient to the MR patient table. These transfers degrade the patient experience and add time to the setup and transfer times.
Figure 3.
The design team studied the movement of patients and technologists to develop meaningful solutions that keep the patient at the center of the MR imaging workflow.
For these reasons, a formational customer need was established to support patient transfer directly from standard wheelchairs. Achieving a design that allows the patient table to be lowered to 53 cm was made more challenging when paired with other design constraints, such as the need for the table to support tabletop movement with patient loads up to 550 lb, requiring substantial mechanical strength. We used this challenge as an opportunity to leverage new battery technology that facilitated the transition from a mechanical (hydraulic) system to one that instead uses electronic lift and drive assemblies for smoother, more comfortable patient transitions in and out of the magnet bore.
Since the introduction of the Discovery™ MR750w GEM, all GE HealthCare MR systems have supported head imaging in a feet-first orientation—a proven strategy to help reduce anxiety and claustrophobia during exams. With our Next Generation MR patient table,‡ we continue this commitment to patient-centered care. The table supports both head-first and feet-first head imaging, giving clinicians the flexibility to tailor exams to each patient’s comfort. The Next Generation MR patient table will also feature a new 70-channel posterior array,‡ designed to deliver expanded scan coverage—especially beneficial for taller patients—without compromising image quality or workflow efficiency.
Figure 4.
Our team evaluated many different customer workflows involving various combinations of staff, staffing levels, staff personas and room layouts. One common request became a key input—make wheelchair transfers simpler. We answered by bringing the table height lower.
Representing a new standard for neuro and head-neck imaging, a 32-channel HNA‡ was developed to put patients first without compromising clinical performance. With an open-face design (approximately 70% facial openness) and increased interior volume, patients experience less anxiety and more comfort—especially during longer scans. Whether scanning head-first, feet-first or using tilt setups, the coil will adapt to the technologist’s workflow while enhancing patient accessibility. Engineered for exceptional image quality, the new HNA will deliver extended anatomical coverage and high acceleration performance, enabling faster scans and sharper diagnostics. Designed to be fully compatible with fMRI and EEG setups, the coil will support advanced research and clinical applications with ease, bringing flexibility to the MR imaging suite.
Supporting staff
Staff may complete 30 to 40 exams during a 10-hour shift. This means 60 to 80 patient transfers in and out of the system. Not only do these transfers take away from precious “gradient time,” they also increase the risk of injury to staff from supporting patient lifts and transfers. In addition to the patient benefit of wheelchair-height tables, the feature also decreases the risk of staff injury by reducing the quantity and distance of patient transfers in a given time period.
We took special care to reconsider the design and materials used in the wheels and steering of the Next Generation MR patient table. We studied the floor plans of several healthcare institutions, some that have very tight corners and severe door thresholds/transitions. Multiple customer floor plans were recreated in our engineering lab to test various design options with internal and external users. Further, by working with our Usability and Test teams, we evaluated several wheel and material options for the table to find the optimal size, design and material to maximize patient and staff comfort in the final design.
The challenge to move from a fully mechanical system to a fully electronic design provides an important simplification. All foot pedals—including docking, wheel locks and brakes—have been replaced with a single electronic control. This simplifies the technologist’s workflow and enables staff to control all table functions with a single hand. This one-handed control also encompasses the action to mate the table to the magnet, aptly named Touchless AutoDock.‡
Touchless AutoDock is a feature we’re especially proud of—the automated docking feature enables the table to autonomously make the mechanical and electrical connections with the magnet without a single touch from the technologist. These connections convey the data acquired through the RF surface coils, charge the table’s battery and permit control of table movement from the operator control room. To autonomously dock the table, the technologist positions the table in proximity to the magnet and the system uses an automated latching mechanism to securely attach the table and data connections to the magnet.
Supporting safe and efficient operations
Engineering excellence is our passion, and putting patients first is our purpose—this could not be more evident in how we prioritize patient safety. A detachable patient table is good for efficiency and good for patient safety. A detachable table allows healthcare providers to rapidly evacuate patients from the MR magnet and examination room and into an area where lifesaving equipment like defibrillators, ventilators or other resources are safe to use. In an emergency, patients scanned on a traditional fixed table must first be transferred to an MR-compatible transfer bed such as a gurney, costing potentially vital moments before emergency staff can safely provide care.
Patients need to hear the technologist during an exam—whether just a reassuring voice like “you’re doing great” or a breath hold command. Technologists may need to provide reinforcement to patients on remaining still or updates on the examination progress. To address both needs, we asked our team to reimagine the intercom system and conceive a design without scanner noise. The spectral characteristics of MR system noise is complex and has historically been challenging to filter using conventional electronics. We once again leveraged the advancements in recent technology to deploy modern signal processing tools to intelligently remove scanner noise, while also leveraging microphone and speaker technology to ensure the patient can hear exactly what they need.
We keenly appreciate the tremendous pressures facing global healthcare institutions in the current environment of rising costs and increasing patient volumes with flat or even decreasing staff and resources. We considered these eventualities and developed a set of hardware and software features in our Next Generation MR Platform to allow users of our technology to streamline workflow using multiple tables. And for sites that already own GE HealthCare AIR Coils or many other legacy coils, they can continue to use them in our Next Generation MR systems—embodying our commitment to the SIGNA Continuum.
Summary
Our team of engineers have spent decades developing MR systems and features with the patient being top of mind. The importance of this mission could not have been clearer than during a memorable observational research visit to a children’s hospital in the U.S. We were onsite for the arrival of a small child being airlifted on Flight for Life.
When we saw all the clinicians working together—anesthesiologists, nurses, respiratory therapists and others—to help an infant complete the diagnostic scan, it was at that point we understood the main task at hand. Our job in design is to help that technologist focus on the patient and the scan, and not on the technology or which button to push. The technology must be seamless and assist the technologist in doing their job, not encumber or limit them. These experiences put into focus what is truly important—patient care. It was clear we had an opportunity to challenge how we approached design projects in the past and closely examine every existing design choice for our Next Generation MR Platform.
That moment remains a strong touchstone for our team—a firm reminder that our work is not simply designing a table or new physiologic gating solution for MR imaging. We are designing tools critical to providing life-saving information to clinicians.
Like any good team of engineers, we find creative solutions to challenges for our customers. We have developed solutions that balance patient experience, scan quality and staff burden; but we’ve also been intentional about putting the patient at the center of everything we do. We’re not just developing solutions, we’re improving patient care in meaningful ways.
‡ Technology in development that represents ongoing research and development efforts. Not for sale. Not CE marked. Not cleared or approved by the U.S. FDA or any other global regulator for commercial availability.
