MRI Monitor
By Jeff Fleming
Radiology Today
Vol. 24 No. 1 P. 28 

Challenges and Opportunities for Next-Generation MRI 

Health care starts with an image. Parsing through the details, shadows, and highlights of a scan, radiologists see every pocket and possibility of a diagnosis to chart the path to treatment.

With six in 10 Americans battling a chronic disease such as heart disease, cancer, or diabetes, many lives are reliant on medical images. This high prevalence of chronic disease feeds into the demand for quick, effective, and noninvasive diagnostic procedures, such as MRI. 30 million MR scans are performed in the United States annually. In fact, over one-half of the 200 radiology professionals polled in a 2022 Bracco survey report an increase in the use of MRI over the last year.

According to the findings, radiologists rank three leading factors in the success of their practices: patient safety, image quality, and the availability of MRI contrast agents. Outside of safety and image quality—which are, perhaps, expected answers—the fact that radiologists list the availability of contrast agents in their success equation shows how timely and top of mind the concern is. We’ve seen that availability is not guaranteed, as COVID-19 lockdowns have triggered global contrast media shortages in recent years.

Most of the attention has been focused on the shortage of CT contrast media. However, it seems supply issues are not only affecting CT scans. The survey confirmed that more than one-quarter (26%) of radiologists have experienced issues with the availability of gadolinium-based contrast agents used in MRIs in the past few years. Outpatient departments (38%) and imaging centers (33%) were more likely to experience delays.

More than three out of five (63%) respondents said it is somewhat or very important that gadolinium-based contrast agents be made in the United States. Reduced concern about availability due to supply chain issues (88%) and support of the US economy (71%) are the top reasons for this viewpoint. 

It may be that concerns over supply chain disruptions are driving another finding in the survey: More than one-third of radiologists (35%) were thinking about environmental impact and sustainability more than a few years ago. That percentage rises among radiologists at large hospitals (40%), perhaps due to the volume of scans performed.

A paper published in Radiology lays out short-term, midterm, and long-term strategies the health care industry can employ to mitigate shortages. But what can diagnostic imaging providers do? It is paramount that no patient be left behind or without access to key diagnostic imaging tools. When COVID-19 disrupted contrast media production, Bracco collaborated with the FDA to temporarily import a nonionic iodinated contrast medium, ensuring patients an alternative option for critical emergency procedures.

Another, more creative, solution to meet urgent clinical needs is to embrace an open innovation approach: joining forces with other companies in the diagnostic imaging space to bring products to patients in the most effective and fastest way possible. On this front, Bracco and Guerbet recently announced FDA approval of their collaboration on a new MRI contrast agent.

Future Collaboration
One of the greatest barriers to health equity and access is overly strict adherence to traditional approaches to knowledge and information sharing. An overwhelming 97% of radiologists in our survey expressed the belief that radiology is ahead or keeping pace with health care advancements. For us to maintain that momentum, collaboration will be a critical factor.

Collaboration will also be an important factor for what the survey cited as the leading concern for 52% of radiologists today: harnessing AI advances. To hone robust AI systems, algorithms must be fed and trained with high-quality data. No single institution holds enough data for proper training of these machine learning algorithms. If AI systems are to reach their full potential, it will most likely be through multi-institutional and multicompany collaborations.

Unfortunately, collaborations of this nature have not been pursued, due to the need for validating and standardizing large data sets of information, which will also require multi-institutional collaboration. A foremost priority for any collaboration will be a focus on sourcing diversified data to ensure unintentional biases are not introduced for underrepresented populations.

It is by no means an easy task, but the value of harnessing this wealth of data will be paradigm-changing, particularly for the field of precision medicine, which tailors treatment management to subsets of patient populations. Our research programs across modalities seek to arm image analysis systems with the ability to detect imaging phenotypes by pairing anatomical parameters with molecular, metabolic, or functional biomarkers. Results to date are promising, indicating that tailoring antiangiogenic treatment and immunotherapy based on functional and molecular imaging may improve survival.

As we look to 2023 with an eye toward future-proofing the medical imaging industry, it will take collaboration from key stakeholders to advance innovation. Academic health centers will continue to serve as identifiers of unmet needs and validators of innovations, thanks to their access to patient populations and data sets. Governments can create policies that reward value-added innovation, allowing the industry to reinvest in additional research. Regulatory agencies can address the pain points in bringing new imaging agents and devices to market, paving the path to patient care for less cost and in less time. Finally, industry leaders must listen to the needs of various stakeholders—providers, payers, patients—and ensure ventures we pursue provide improved health outcomes and reduced spending.

Beyond selecting the most pressing unmet needs, industry leaders must do what they can to speed the adoption of innovations by providing education, training, and even the development of guidelines. Most importantly, industry leaders must remember that our work is not done once a product, platform, service, or technology hits the market. It is not only the introduction of new innovations but also the refinement of existing ones that will advance radiology for decades to come.

Whether we’re talking about AI and precision medicine or new contrast agents, a key takeaway is that the road to innovation often lacks involvement from radiologists themselves. By bringing in the perspectives of those on the frontlines, we can hone our focus on where to improve techniques and processes.