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RWJ Barnabas Health Ambulatory Care Center is a hospital-based outpatient facility in Livingston, New Jersey, that includes state-of-the-art imaging, covering magnetic resonance (MR) imaging and MR spectroscopy, positron emission tomography, and high-end breast imaging, including 3D mammography and a comprehensive breast interventional suite.
Indeed, thanks to the clinic’s continuous investments in imaging technology, its radiologists and technologists are able to perform a wide range of oncology, neurology, body imaging, radiation oncology, breast imaging, and other studies to meet the needs of their communities.
The imaging department recently added a new Philips Ingenia Elition3.0T system that offers breakthrough diagnostic quality and speed. “This system is really giving us the ability to do everything we can do with high-end MR,” says Kris Giordano, Director of Imaging. “We can work in conjunction with radiation oncology, run various neuro applications, and perform diagnostic breast MR imaging.  Overall, we do a tremendous amount of consistent work on a day-in and day-out basis.”
The Ingenia Elition with Compressed SENSE, a breakthrough acceleration technique that shortens single MRI sequences and full MRI examinations, performs MRI exams up to 50% faster than conventional MRI exams, while continuing to deliver superb image quality. Its shorter overall exam-time is achieved with the help of a touchless guided patient setup that improves patient exam setup time at the bore, combined with accelerations in both 2D- and 3D scanning. In addition, the Ingenia Elition offers an immersive audio-visual experience to help calm patients and guide them through their exams, which helps clinicians acquires high-quality images with less repeats.
RWJ Barnabas’s initial goal was to alleviate backlogs and appointment bookings for Multiple Sclerosis and neuro studies, while also accommodating a growing referral base for oncology and orthopedic studies. “We really wanted to meet that demand with a system that we knew was going to be reliable and consistent,” says Giordano. “What we didn't expect with this system was the homogeneity, even at 3T, where body work, image quality, consistency and the time savings is so stellar that we started seeing body clinicians asking for this 3T system.”
With Compressed SENSE, Philips reduced a 3D respiratory-triggered magnetic resonance cholangiopancreatography (MRCP) exam, a common non-invasive technique for evaluating biliary and pancreatic ducts, from 4 minutes 30 seconds to 1 minute 12 seconds. Giordano’s department has also developed new imaging sequences with Compressed SENSE.  “Compressed SENSE is the best thing since sliced bread. It’s a speed demon,” says Giordano. “That gain in speed improves patient compliance, increases our completion rate, and definitely delivers confidence to referring physicians.”
He notes that Compressed SENSE is particularly useful in neurological studies and Magnetic Resonance Angiography (MRA) exams. It has reduced 3D Time-of-Flight scans of the carotids from nearly 8 minutes to just 57 seconds and scans on MS patients take just 16 minutes, such as a cervical spine MRI with contrast.  “The ability to acquire them in such a speed and reproducible image quality, and the fact that we're able to gain those completions and not lose those table slots has been truly a game changer,” he says.
Designed for patient comfort
The Elition is designed with features to get patients in and out of the scanner faster. Its wide bore reduces patient anxiety, and its concave table and memory foam pads improve patient comfort. One of the biggest improvements the RWJ Barnabas team has seen is in patient compliance, driven by Compressed SENSE, motion correction software and the Elition’s audio-visual experience.
“Patients love it because they can get through the exam quickly. It's a nice wide bore. We simply use the auto voice and we can conduct breath-holds in their language. That feature in and of itself has tremendously improved our compliance,” says Giordano.
He especially appreciates the ability to adjust the head coil to accommodate kyphotic patients or patients who can’t lie completely flat. “No matter what approach we take, we're able to truly ensure patient comfort and then we're not limited by position. Essentially, wherever the patient is lying, you're able to scan them.”
MS patients undergoing a brain cervical thoracic study with contrast, for example, experience a scan that now takes about an hour instead of two-and-a-half hours. One patient recently commented that she only received “half a study” when her abdominal scan on the Elition took only 12 minutes instead of the usual 45 minutes on another scanner.
“It's almost as if, by virtue of installing that system, we've changed the narrative of what MR has become,” says Giordano.
AI solutions for consistency and confidence
The Elition also leverages several features, such as SmartExam, that Giordano initially greeted with skepticism but has now come to appreciate.
SmartExam Brain helps deliver reproducible planning results by using software that automatically plans the scanning geometries, based on the radiologist’s validated scanning preferences. This enables Giordano’s staff to standardize MRI exam processes, enhancing consistency both from patient to patient and in follow-up exams.
“The SmartExam options and the automated planning and positioning only help us to increase that confidence and consistency. I think it's a really good feature to have. Every brain is going to be positioned angle to the corpus callosum, the way that our radiologists want, desire, and plan for, so we achieve that consistency across the board,” he says.
Confidently Imaging Implant Patients
To simplify scanning for patients with MR Conditional implants, the facility uses ScanWise Implant software.
Once a clinician has identified the conditional parameter values specified by the implant manufacturer, ScanWise Implant’s user interface guides them through simple steps to enter these parameters. With the help of the guided user interface, the implant conditions can be entered in 3 minutes or less.
Then technologists enter the parameter values of the Conditional implant once for the whole exam, rather than scan by scan. The software automatically adjusts the scan parameters for all scans and pre-scans throughout the whole exam. ScanWise Implant helps reduce guesswork by eliminating the need for the technologist to do any calculations or repeatedly add or check information for every sequence of the exam. It also increases staffing flexibility because it can be operated with confidence by well-trained radiographers of all experience levels.
ScanWise Implant allows clinicians to confidently offer MR imaging to a growing and potentially underserved subset of the patient population, enhancing a facility’s reputation and encouraging referrals.
Better workflow and scheduling
As for scheduling, the department initially reduced its typical hour-long slots to 45 minutes on the new system. Gradually, they’ve been tapered to 30-minute slots, permitting as many as 26 exams to be performed each day, up from 14 MR exams daily.
Giordano says Philips has made working with the new system virtually seamless. “It's the learning curve and getting everyone to have total confidence that could definitely be a challenge,” he says. “With Philips, there has been a tremendous ease of that transition. The onsite applications training is vital. The help lines that are accessible 24/7, are vital. I can't tell you how many people I've never met in person, but I've called so many times. I know them by name.”
Customer Support during COVID-19
The Philips partnership includes virtual training to accommodate social distancing directives under COVID-19.  “They’re ensuring that they're still supporting us and the patients that we're imaging. Because what we're trying to do is ensure that the patients have the best opportunity to have their images done right the first time,” Giordano says.
MR imaging during COVID-19
COVID-19 has disrupted every aspect of everyday life, especially in healthcare. At RWJ Barnabas Health Ambulatory Care Center, all routine scans have been canceled and only urgent studies are being performed.
“We have to look at our hours of operation and foot traffic so that we’re not in any way, shape or form a contributor towards any infection spread,” Giordano says.  The facility takes extra precautions to screen every patient for COVID-19 symptoms before they enter the building. Inside the building, patients undergo an expedited registration and intake process, and then are directed to an isolation or staging room. Each room is cleaned and disinfected.
Half of all waiting room chairs were removed to accommodate social distancing. Patients are scheduled to reduce simultaneous foot traffic, and appointments on the facility’s four magnets are staggered. Imaging rooms and equipment are thoroughly wiped down and allowed to dry completely between studies. Management is also keeping a daily tally of PPE supplies, as well as PPE run rates per modality to ensure they have proper supplies.
“We're used to being a high-volume outpatient imaging center where everything is go, go, go, go, go, go. But COVID says no, no, no,” says Giordano.  Despite the challenges, he’s impressed by how his staff – and the entire healthcare community – has stepped up to mitigate the risk of COVID-19.  “I have been unbelievably awed at the outpouring of anybody willing to jump in and do whatever's needed to be done,” he says. “We call this group of people our coworkers, but really they're friends or colleagues, and we're all in this together.”
Editor’s Note: Royal Philips is a leading health technology company focused on improving people's health and enabling better outcomes across the health continuum – from healthy living and prevention, to diagnosis, treatment and home care. Philips leverages advanced technology and deep clinical and consumer insights to deliver integrated solutions. Headquartered in the Netherlands, the company is a leader in diagnostic imaging, image-guided therapy, patient monitoring and health informatics, as well as in consumer health and home care.
Disclaimer:  Results from case studies are not predictive of results in other cases. Results in other case studies may vary.