My MRI Crystal Ball…

Anyone who has lived in the middle part of the country probably has a healthy disdain for the word “forecast” since the local news weathercasts in this part of the world are often flummoxed by what’ll happen later today, to say nothing of three days from now. Similarly, “prediction” conjures up recollections of mid-season prognostications--seemingly universally wrong--about which teams will ascend to the World Series or Superbowl. Personally, I prefer the enigmatic sounding “futurist,” but whichever description works for you, they all somewhat describe what I was recently asked to do...

I often get asked to give presentations or audio conferences on the intersection between imaging and architecture. Most often these are a combination of one-part conventional wisdom, two-parts current events, a dash of crucial technical information and a generous pinch of “learn from someone else’s mistake” examples. Earlier this month I was challenged to look forward to the next 10 plus years of MRI technology and the ramifications for imaging providers. The experience was, in a word, enlightening.

Imaging is expensive. Not simply the out-of-pocket costs for a contrast CT for John Q. Uninsured, but the equipment, facilities, support and staff requisite to all of radiology. When a purchase is expensive, it’s natural to try and diminish the concerns about failure by building a rationale, clinical or financial, based on established need. We do this for equipment purchases. We do this when planning new facilities. We do this when calculating how many FTE’s are needed. In short, many (most?) of our radiology capital-intensive decisions are made looking back on where we’ve been, instead of looking forward to where we’re going.

Imagine navigating all the way from home to work by looking only in your rearview mirrors for the entire drive. This is what we do in radiology, and this is precisely why an exercise dedicated solely to looking forward offers a wealth of new decision inputs.

Looking back over the recent past of MRI we are all struck by the declines in reimbursement, particularly for IDTF facilities. Knee-jerk reactions are to slash costs or count on increased volume from shuttered competitors to preserve profitability. But what are the future factors that will influence the financial aspect of MRI?

If we look at the original single-slice CT and recognize that exam times used to approach an hour, it’s patently obvious that we have made enormous strides in CT throughput. While we may never get an MRI study down to 10-12 minutes, you can bet that stronger magnets, faster gradients, improved software, multi-channel coils and innumerable other advancements are all pushing diagnostic exam times downward for MRI. There are currently providers who have 20 minute standard exam schedules for MRI, and these efficiencies will continue to expand.

Just a year or so ago it seemed that popular wisdom held that 3T systems weren’t ready to emerge from the research setting for widespread clinical use. By late last year, sales of 3T systems were the fastest growing MR type while sales of new low-field systems had nearly evaporated. Based on the last 20 years of precedent, today’s research MR systems will be tomorrow’s clinical MR systems. MRI manufacturers are struggling to keep up with the orders for special ultra-high field systems (5T and greater). FDA safety clearance for MRI already extends up to 8T, and the University of Illinois just received safety clearance for their 9.4 Tesla human MRI.

Apart from the financial and technical components, the entire issue of who will be receiving MRI scans is also undergoing a substantial shift. The per-capita use of all imaging studies, including MRI, increases dramatically with age. As the initial bolus of baby boomers is silently slipping over the AARP threshold, rates of imaging utilization in the U.S. can be expected to continue the double-digit growth that we’ve seen in the newer technologies.

When taken together (and with other factors such as clinical applications, which I haven’t touched on here), the future path of MRI may not be perfectly detailed, but the direction seems quite clear. We will be imaging more patients, faster than ever before, on successive generations of stronger and stronger magnets. Reimbursement will continue to decline, spurring greater efficiency gains in patient throughput from operations and technical advancements.

The radiology “winners” in this tumultuous period will be those who can cast at least one eye toward the future when making today’s plans. Doing so, however, will likely require a departure from conventional practices, as well as a willingness to trust in the inevitability of tomorrow.