By Dr. Philip Chao

A phobia is an “irrational fear of a specific object, activity, or situation that leads to a compelling desire to avoid it.” Fear of being inside an MRI scanner causes many patients to avoid even considering having one, depriving themselves of the necessary information that such a test can provide. At MRI Consultants/Best Open MRI, we are aware of this problem, and, when it came time to invest in a new MRI scanner, we did so with the patient in mind. The scanner we installed approximately one year ago is a Siemens Espree—the most powerful “Open” MRI made today.

Wide Open MRI. Not only is it the most spacious MRI scanner with an extremely high weight limit, it also has 18 channels, the latest MRI software, and a 1.5T magnet, which makes it a strong competitor against all of the closed MRI scanners in the State.

Our new Siemens Espree has a bore that is 70 cm wide and a weight limit of 550+ pounds. The top of the scanner is more than a foot above the patients head! And the bore is only three feet long, so no matter what you’re having scanned, your entire body is never in the scanner. In fact, for most studies, a patient’s head will not be in the magnet … allowing the patient to watch a favorite DVD on the 52” flatscreen TV we installed in the ceiling! As a result, many people whose claustrophobia kept them from being able to have an MRI elsewhere have been able to have one at our facility. Approximately 30% of our patients come to us after having been unable to have an MRI somewhere else.

In addition to our wider bore and higher table weight, we also offer patients the option of doctor-monitored, IV sedation. If claustrophobia is a concern, ask your Imaging Center if they provide IV sedation before scheduling. It really can make a difference. We offer it at no additional charge, and, over the past 3 years, we have never had a failure. We only ask that you bring someone to drive you home afterwards!

But, even with the best of equipment and intentions, there remains a small subset of patients – perhaps 2% of our patients – who, because of their phobia, cannot even venture into the scan room. These patients will not allow themselves to be sedated because they simply cannot enter the room. For those that are willing, we have a method to help desensitize these patients. We offer a 5-step method to all (at no additional charge) that no other MRI facility offers.

Step 1 is to simply to come in and see our spacious office, which was specifically designed to allay patient anxiety, from the Indigo colored walls to the massage chair in the waiting room. Patients are encouraged to take a tour of our state-of-the art facility — Delaware’s finest. They are able to look at the scanner from the outside.And, if the patient being scanned agrees, the patient with the phobia can even watch their scan.

Step 2 is to go to the door entrance, which involves “de-metalling yourself” as you would for an actual study. But, you do so knowing you
will not have a scan. It is just the exercise.

Step 3 is entering the scan room. Patients get a chance to look all around the scanner and see the window which allows sunlight to stream into the scan room and the TV in the ceiling. In fact, anyone over the height of 5’3” being scanned below the waist (including the pelvis and lumbar spine) can bring their favorite DVD to watch while being scanned.

Step 4 is coming into the room and just sitting on the table—just to get a feel for it.

Step 5 is to actually lie down on the table as if getting ready for sedation or the exam. To be perfectly honest, most patients do not take the time to do all 5 steps, finding they are able to move to having the study done after only one or two visits, but we feel it important to offer this solution for our claustrophobic patients. While desensitization is a well-known treatment for phobias, we are aware of no other Imaging Center that offers one for MRI (at no charge to the patient). www.bestopenmri.net.

MRI truly is a remarkable test. It does not use any ionizing radiation and, unlike CT scans and x-rays, it does not cause cancer (many lymphomas today are from CT scans several years ago). In fact, some types of CT scans are an extraordinary amount of radiation. A CTA (CT angiography) scan of the coronary arteries is the equivalent of approximately 1,550 chest x-rays! An MRA of the coronary arteries shows the same anatomy without any ionizing radiation.

The FDA has been investigating irregularities with CT scanners, some of which randomly deliver up to 12 times the normal dose of radiation without warning. These CT scanners have caused radiation burns and loss of hair in patients. MRI can be of use to us all for several important reasons. In just this winter season, we found two fractures totally missed by multiple sets of xrays. Many patients do not realize that MRI can find stress fractures. And, of course, for brain and spine studies, MRI is unsurpassed in detail. In the abdomen MRI can find more liver tumors using a new agent called Eovist (60% more). In patients with MS, we see 40% more lesions. In patients with cancer, we see 20% more lesions. www.3t-mri.net.

We were the first facility to use the more effective and sensitive technology of 3T MRI to do breast imaging. Breast MRI should be used in patients with a high risk of breast cancer or a problem mammogram. But every breast MRI patient should consider that doing the study on a 1.5T scanner means their cancer could be missed. 3T MRI is 100% sensitive. (www.3tbreastmri.com).

There is a rumor that 3T scans have more false positives, but there isn’t actually any hard data to support this. In fact, the higher resolution and thinner sections allow us to be more specific and better characterize lesions. (www.mriconsultants.net). Our new facility in Rehoboth Beach will be equipped with the very latest breast coil—the Sentinelle. This adjustable breast coil is coming to our scanner to be installed in Rehoboth Beach. It will be the finest Breast MRI scanner in the world. It will have the detail of 3T MRI with the spaciousness of 70 cm OPEN BORE technology.
3T OPEN MRI is coming to Delaware soon. www.open3t.com

Keep in mind that MRI technology advances as the same speed as computer technology, and there are actually a number of facilities out there scanning patients with MRI machines that are 15-years old! You really need to have a machine less than 3 years of age to have the latest technology. Among the softwares and features available in recent machines are REVEAL, which shows early cancer (we do it for free on your abdomen studies); NATIVE, which lets us see your arteries without dye injection—ideal for routine MRA of the brain or neck; and BLADE, which compensates for movement: a patient who is unable to remain perfectly still no longer has to have blurry images! All of these make for better images. Ask for them. Sadly, there are radiologists who do not know how good these advancements are because their own scanners are too old to use them! You deserve better. Get the best.

Dr. Philip Chao graduated Phi Beta Kappa from Yale University and was Scholar of the House. He continued his studies at the University of Rochester School of Medicine and Dentistry, receiving his medical degree in 1983. After a transitional internship year at the Mary Imogene Bassett Hospital in Cooperstown NY, Dr. Chao did his residency in Radiology at Brooklyn’s SUNY Health Science Center (1984-1987), where he became Chief Resident. He stayed on to complete a fellowship in Neuroradiology (1987-1988). Dr. Chao has been interested in MRI technology since its very beginning – the first MRI scan took place in 1981 while he was pursuing his medical studies. The University of Pennsylvania, where Dr. Chao was both a Body MRI Fellow (1988-1990) and a Neuroradiology Fellow (1989-1990), was at the heart of the development of this technology and Dr. Chao was able to work with pioneers in MRI on the first GE Signa 1.5T (tesla) scanner. His advanced research and specializations complete, Dr. Chao left the University of Pennsylvania for a position as Director of MRI in Wilmington DE – a position he held for 14 years. Dr. Chao eventually left that position to create the best MRI center in Delaware, using the very latest technology: 3T MRI. While 3T (tesla) scanners have been used for scanning research patients since 2002, these advanced, more powerful MRI scanners only became available for clinical use in 2004. Dr. Chao worked hard to bring 3T technology to Delaware and in February 2007, MRI Consultants, LLC began operating the first 3T scanner in the State. 3T is the newest horizon for MRI.