Comment Re:I wonder if they will be charging the same amou (Score 5, Informative) 26
I was wondering when something like this was going to come out. There had already been the development of portable CT scanners for ICUs about 10 years ago. Development of portable head MRI units was an obvious next step. Additionally, unlike for CT, scaling down a CT scanner doesn't help all that much in terms of cost. Whereas for MRI, the cost savings are vast.
There are major disadvantages with this machine, however. You wouldn't want to use it if you had access to a more conventional MRI scanner. It is very low field due to the use of permanent magnets - this cuts your signal-to-noise ratio by an order of magnitude, and takes away a huge amount of flexibility in terms of resolution/speed trade off. You could do a minimal head exam in 30-40 minutes, whereas a high quality superconducting system could do a full neuro protocol at double the resolution with far higher diagnostic performance in the same, or do the minimal protocol at the better resolution and better SNR in 10 minutes. There is also the issue of size - the system is extremely small, and far more claustrophobia inducing than a conventional scanner (for head scans). The low field strength also translates into terrible performance for detection of small blood clots (like epidural or subdural hematomas) - the visibility of the blood depends on it's magnetic properties, and the interaction with the scanner's magnetic field. Stronger magnetic field drastically increases this effect, over and above the drastically higher SNR.
However, for the intended use case, which is neuro ICU where patients are too unwell to be transported to the MRI department, this is an incredible development. You can diagnose stroke with near 100% accuracy without leaving the ward. You can also diagnose other causes of sudden deteriotation, like hydrocephalus, large epidural/subdural hematomas. By avoiding the need for a complex transfer (potentially with extensive support equipment, such as ventilators, monitoring equipment, etc) you can shorten the time to diagnosis, and therefore treat the cause of the deterioration faster.
This unit does not compete as a replacement for a general purpose superconducting system for non-urgent cases, but may have a role in situations where a superconducting MRI system is unaffordable, such as developing countries, where the cost of even a basic MRI scan can exceed a month's wages. Most importantly, due to it's small size, it will not be able to fit body parts larger than the head - so would be limited to extremities like wrists, hands, feet and knees, and possibly the neck.
In some sites, portable CT is being used for a similar purpose - but even the best CT is poor in terms of anatomical detail compared to even low field MRI. There are also significant radiation protection concerns when portable CT units are used, for both staff and other patients - as ICU rooms lack the lead-lined walls of a proper CT suite. This MRI unit avoids the radiation concerns.
In MRI, the major costs are the magnet - typically a superconducting system of 1.5 T or 3T. These are large complex and very expensive devices, requiring substantial energy and substantial support plant - and the gradient set (a set of 3 orthogonal electromagnets which dynamically distort the main magnetic field in a precisely controllable way). The costs of superconducting magnets scale roughly proportionally to the radius to the 4th power, and the cost of the gradient equipment scales roughly proportionally to the radius to the 5th power. The move from 60 cm diameter MRI systems (which are limiting due to claustophobia and in the case of obesity) to 70 cm systems (which are now standard) has come with a rise in cost.
The change in diameter also needs a significant increase in support plant. One manufacturer is offering an refurbishment service for their old scanners which replaces the gradient system with a much thinner system, increasing the bore of the scanner from 60 to 70 cm diameter, while simultaneously increasing the performance of the gradient set. This comes at a substantial price in terms of the building services required - a 150 kW 3 phase electricity supply is no longer sufficient, as the new gradient amplifiers (capable of delivering 2.7 MW energy pulses) now need a 300 kW supply, together with a concomitant upgrade in chilled water and HVAC. This is something which has proven a significant barrier for sites with an EOL system, looking to upgrade it to the current specification, only to find that they cannot accommodate the services.
However, in turn, when down-scaling the magnet (in particular, to the use of low cost permanent magnets) huge cost reductions can be achieved (think replacing a $1 million superconducting magnet with a $10k rare earth magnet), and similarly down-scaling the gradient unit will also result in huge cost savings due to the reduction in the quantity of power electronics required (no longer need a $500k system capable of handling multi-MW pulses, when a $10k system capable delivering 10 kW pulses is all you need).
There are of course new safety concerns with this device - however, the low field, and small size of the magnet should mean that the hazard zone is much smaller than around existing MRI devices. However, you have the new risk that the hazard zone moves with the scanner - so this will require new MRI safety practices. There are also safety issues regarding metallic or electronic implants - in general, for things like screws and plates (which aren't really an issue anyway), the low field has fewer issues than high field systems. However, electronic devices like pacemakers, neurostimulators and so on pose a more difficult problem. For these device, the major hazards are EMI from the scanner (either from it's RF transmitter or the gradient system). For the RF transmitter, currents may be induced in implanted wires, but the amount of current depends on the geometry of the wire as an antenna, and whether it is resonant with the scanner's frequency, which in turn depends on the magnetic field strength. There is an industry agreement among medical device developers to only qualify their devices for compatibility with 64 MHz RF (corresponding to 1.5T superconducting systems), and that the different frequency may pose unrecognised hazards if it hits a resonant mode of the implanted device. The mitigating factor is that the small size of the scanner minimizes the amount of the body exposed to RF (and also gradient related EMI) - so even though a pacemaker may be labelled as only qualified for 1.5 T MRI, and therefore this scanning with this type of low field system would be against instructions - the fact that the chest would be well outside the scanner unit, may serve to reduce the risk - although this is difficult to quantify without either extensive numerical RF simulations and/or physical experiments with an instrumented pacemaker implanted in a human shaped gel block.