Earlier this year, Next Generation Imaging LLC opened the doors of their Charlotte Avenue office near downtown Nashville. At the cornerstone of the diagnostic imaging center's services is the state's first Upright MRI.
Developed and manufactured by Fonar, the UPRIGHT® Multi-Position™ MRI allows patients to sit, stand, bend, lean or lie down. The concept behind the dynamic imaging equipment is that patients can be scanned in the positions in which they experience pain.
David H. McCord, MD, a board-certified orthopedic spine surgeon who has a financial interest in Next Generation Imaging, was instrumental in bringing the Upright MRI to Nashville. He called the technology "revolutionary" and "unique."
He believes the equipment provides a more accurate diagnosis by catching issues that might not be apparent during conventional MRI when a patient is lying on their back without the pressure of standing or moving.
"There's a fairly significant failure rate—failed surgery and failed non-surgical treatments. As a spine surgeon, I thought, 'Let's diagnose this more accurately … more straightforwardly,'" he recalled.
Referring to a study based at UCLA that was presented at the annual meeting of the North American Spine Society (NASS) in October 2007, Tara McCormick, director of marketing for Next Generation, said, "This magnet … because it is weight-bearing and multi-positional … gives people approximately 30 percent more pathology than other MRIs."
She continued, "We image the patients in their position of pain to provide the most pathology possible, which would equal a more accurate diagnosis."
During the NASS meeting, four scientific papers were shared comparing the visualization of spine pathology with Dynamic™ MRI (the Fonar Upright) and Static MRI. At L4-5, which is the vertebral level responsible for nearly half of lumbar disc herniations, 35.1 of the spondylolistheses seen with Dynamic MRI were missed with traditional recumbent MRI. ("The Spine Journal" supplement, September/October 2007, Vol. 7, No. 5S.)
McCord added a key strength of the Upright MRI is the ability to capture images of movement that patients find painful in the course of daily living. "The Fonar machine can handle someone twisting like a golf swing," he pointed out. "You get a more accurate reflection of what's going on. Because it is open, you can get into almost limitless positions in the magnet."
He explained that when lying down, the pressure comes off of painful joints or the spine, which therefore might appear to be normal in a traditional MRI setting. However, when a patient is standing, bending or in another weight-bearing position, the spaces between the joint or spine narrow, and problems can be more readily seen. McCord added a 200-pound patient could have as much as 500 to 600 pounds of pressure through their disc space when in a weight-bearing position.
McCord noted the equipment's truly wide-open nature is also ideal for patients who suffer from claustrophobia or for young patients who can be imaged sitting on a parent's lap while watching television. McCormick added the ability to image pediatric patients without sedation was another plus. She also said the higher weight tolerance was an important feature that allowed imaging of larger patients.
"We can get patients up to 500 pounds in our scanner as compared to the traditional recumbent MRI, which is only 300 (pounds)," she said.
According to McCormick and McCord, the Upright MRI uses the same billing codes and is covered in the same manner as traditional recumbent MRI. McCord said that many providers are using it as a second line of diagnostic information if a traditional MRI doesn't reveal a problem despite a patient experiencing pain. However, he said he believed the improved pathology and cost effectiveness really meant the Upright MRI could be the first-line option. The diagnostic capabilities include the spine, neck, knees, hips, ankles and other painful joints.
"There are potentially a fair number of patients out there that could be more accurately diagnosed," McCord said. "It's a really good added tool in the box."
He concluded, "It's the best option currently available that can allow physicians to have the best information, and let patients have a more cost effective and accurate treatment."