Upright/Open MRI – Criteria Led Commissioning Statement

Scope

This commissioning statement refers to:

  • Current uMRI scanners generally use medium field magnets of 0.5T or 0.6T. uMRI here refers to any system of 0.5T or greater that allows for scanning in various positions, regardless of manufacturer.
  • By comparison, the most advanced standard rMRI scanners have magnet strength of at least 1.0T and up to 3.0T allowing for the greatest resolution generally in a shorter amount of time. With 0.6T magnets, uMRI requires more time to obtain images with lower resolution.
  • Slower imaging times with uMRI may create difficulty for patients who are unable to remain still while in a standing or sitting position; not comfortable secondary to pain; or are unstable in such positions. Longer exam times may also decrease the overall patient flow and volume of patients that can be accommodated.
  • The proposed advantages of uMRI are based on the ability to scan the spine (or joints) in different positions (including the position where clinical symptoms are more pronounced) and assess the effects of weight bearing, position and dynamic movement. It is theorized that such positional imaging may provide information not available from methods currently used (i.e. supine conventional MRI) and that this added information will lead to improved diagnosis, treatment and outcomes.

Status

Eligibility Criteria

Referral for Open MRI scanning of at least 0.5T as an alternative to conventional MRI may be commissioned in the following circumstances as an exception where the following criteria is met:

  • patients who suffer from claustrophobia where an oral prescription sedative has not been effective (flexibility in the route of sedative administration may be required in paediatric patients as oral prescription may not be appropriate).
  • For the use for Spinal cord compression and neural axis tumours. The use of Open MRI is recommended rather than the use of a general anaesthetic as there is a lesser risk to the patient
  • patients who are obese and cannot fit comfortably in conventional MRI scanners as determined by a Radiology department policy. (The issue re size is how the weight is distributed)
  • patients who cannot lie properly in conventional MRI scanners because of severe pain
  • And the purpose of the scan is a last resort to exclude larger lesions if this is clinically relevant in the brain and spine. Peripheral body parts will not normally be considered for upright MRI unless at the specific request of an acute consultant who believes this is essential to clinical management due to failed trial of single body part MRI.
  • AND the patient is registered with the GP Practice
  • IN ADDITION The CCGs will only fund uMRI of the specific anatomy requested.

Lifestyle Factors - Best Practice

Obesity

  • Patients with a BMI >30 should be encouraged by their Clinician to lose weight prior to surgery and signposted to appropriate support to address lifestyle factors that would improve their fitness for surgery and recovery afterwards.
  • There is a clinical balance between risk of surgical complications with obesity and the risk to delaying any surgery.
  • See Weight Management Care Pathways

Smoking

  • In line with 'Healthy Lives, Healthy People; a tobacco control plan for England', local authorities and health professionals are committed to encourage more smokers to quit.
  • Smoking remains the leading cause of preventable morbidity and premature death in England.
  • There is sufficient evidence to suggest that people who smoke have a considerably increased risk of intra- and post-operative complications such as chest infections, lung disorders, wound complications and impaired healing.
  • See Smoking Cessation Care Pathways
Please Note: The life style factors above are not a restriction to the commissioning statements unless otherwise stated

Evidence/Rationale

See References

References

  1. North American Spine Society (NASS). Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis. January 2013 http://www.spine.org/Documents/Lumbarstenosis11.pdf accessed July 2013
  2. Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis. January 2013 http://www.spine.org/Documents/Lumbarstenosis11.pdf accessed July 2013
  3. American College of Radiology (ACR). PRACTICE GUIDELINE FOR THE PERFORMANCE OF MAGNETIC RESONANCE IMAGING (MRI) OF THE ADULT SPINE. 2012. http://www.asnr.org/sites/default/files/guidelines/MRI_Adult_Spine.pdf accessed July 2013
  4. Skelly AC, Moore E, Dettori JR. Comprehensive evidence-based health technologyassessment: Effectiveness of upright MRI for evaluation of patients with suspected spinal or extra-spinal joint dysfunction. Washington State Health Care Authority. May 11, 2007. Available at:http://www.hta.hca.wa.gov/documents/uMRI_final_report.pdf accessed July 2013
  5. ACR PRACTICE GUIDELINE FOR PERFORMING AND INTERPRETING MAGNETIC RESONANCE IMAGING (MRI). Revised 2011. http://www.acr.org/~/media/EB54F56780AC4C6994B77078AA1D6612.pdf accessed July 2013
  6. National Institute for Health and Care Excellence. Low back pain Early management of persistent non-specific low back pain. May 2009. http://www.nice.org.uk/nicemedia/live/11887/44343/44343.pdf accessed July 2013
  7. Liodakis, E, Kenawey, M, Doxastaki, I, Krettek, C, Haasper, C, Hankemeier, S. Upright MRI measurement of mechanical axis and frontal plane alignment as a new technique: a comparative study with weight bearing full length radiographs. Skeletal Radiol. 2011 Jul;40(7):885-9. 8
  8. Kanno, H, Ozawa, H, Koizumi, Y, et al. Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis. Spine (Phila Pa 1976). 2012 Feb 1;37(3):207-13.
  9. Andreasen ML, Langhoff L, Jensen TS, et al. Reproduction of the lumbar lordosis: a comparison of standing radiographs versus supine magnetic resonance imaging obtained with straightened lower extremities. J Manipulative Physiol Ther. 2007;30(1):26-30.
  10. Ferreiro PA, Garcia IM, Ayerbe E, et al. Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol. Apr 3 2007.
  11. Hirasawa Y, Bashir WA, Smith FW, et al. Takahashi K. Postural changes of the dural sac in the lumbar spines of asymptomatic individuals using positional standup magnetic resonance imaging. Spine. 2007; 32(4):E136-140.
  12. Kanno H, Endo T, Ozawa H, et al. Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976). 2011 Jan 20. [Epub ahead of print]
  13. Karadimas EJ, Sodium M, Smith FW, et al. Positional MRI changes in supine versus sitting postures in patients with degenerative lumbar spine. J Spinal Disord Tech. 2006; 19 (7):495-500.
  14. Kong MH, Hymanson HJ, Song KY at al. Kinetic magnetic resonance imaging analysis of abnormal segmental motion of the functional spine unit. J Neurosurg Spine. 2009 Apr;10(4):357-65
  15. Washington State Department of Labor and Industries. Health Technology Assessment Standing, Weight-Bearing, Positional, or Upright Magnetic Resonance Imaging. May 31, 2006. http://www.lni.wa.gov/ClaimsIns/Files/OMD/StandMriTAMay2006.pdf accessed July 2013
  16. Madsen R, Jensen TS, Pope M, et al. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis. Spine 2008 Jan 1; 33(1):61-7.
  17. Hayashida Y, Hirai T, Hiai Y, et al. Positional lumbar imaging using a positional device in a horizontally open-configuration MR unit - initial experience. Journal of Magnetic Resonance Imaging 2007 Sep; 26(3):525-8.
  18. Arcadias EJ, Siddiqui M, Smith FW, et al. Positional MRI changes in supine versus sitting postures in patients with degenerative lumbar spine. J Spinal Disord Tech. 2006; 19(7):495-500.
  19. Hailey D. Open magnetic resonance imaging (MRI) scanners. Issues in Emerging Health Technologies. Issue 92. Ottawa, Canada; Canadian Agency for Drugs and Technologies in Health (CADTH); 2006.
  20. Siddiqi M, Nicol M, Efthimios K, et al. The Positional Magnetic Resonance
  21. Imaging Changes in the Lumbar Spine Following Insertion of a Novel Interspinous Process Distraction Device. Spine. 30(23):2677-2682, December 1, 2005.
  22. Kimura S, et al., Axial load-dependent cervical spinal alterations during simulated upright posture: a comparison of healthy controls and patients with cervical degenerative disease. J Neurosurg Spine, 2005. 2(2): p. 137-44.
  23. Jinkins JR, Dworkin JS, Damadian RV. Upright, weight-bearing, dynamic-kinetic MRI of the spine: initial results. Eur Radiol 2005; 15(9):1815-25.
  24. Smith FW, Siddiqui M. Positional, Upright MRI Imaging of the Lumbar Spine Modifies the Management of Low Back Pain and Sciatica. In European Society of Skeletal Radiology (ESSR). 2005. Oxford, England.

Assurance & Governance

  • This policy was developed on: 05.2017
  • This policy was approved by: Clinical Strategy Group (NK) and Clinical Cabinet (WK)
  • Date approved: 05.2017
  • Publication Date: 05.2017
  • Review Date: 04.2018
  • Ref No: PA19 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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