BG-09 MRI 6/8/07 20:54 Page 138
09 MRI SCANNERS: A BUYER’S GUIDE
MRI SCANNERS:
A BUYER’S GUIDE
D. Price, I. Delakis, C. Renaud and R. Dickinson
Correspondence The UK National Health Service
Centre for Evidence-based Purchasing (NHS) Purchasing and Supply
152C Skipton House Agency (PASA) Centre for
80 London Road Evidence-based Purchasing (CEP):
London has produced a series of
SE1 6LH
comparative reports on the
UK
specifications and technical
Website: www.pasa.nhs.uk/cep performance of both 1.5 and 3 Tesla
(T) closed system magnetic
resonance imaging (MRI)
equipment, to help inform buyers’
purchasing decisions.
Seven 1.5 T models, produced by
GE, Phillips, Siemens and Toshiba,
and four 3 T models, produced by
GE, Phillips and Siemens, were
evaluated (figure 1; table 1). The
latest reports, which were first
published in May 2007, form the
basis of this article [1, 2].
138 THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
Developments in MRI
Effective diagnostic imaging has a
key role in ensuring that patients
have speedy access to appropriate
treatment. The UK Department of
Health has prioritised imaging as
part of its progress towards meeting
its 18-week referral-to-treatment
target, due to be implemented by
the end of 2008.
Most hospitals buy 1.5 T systems.
These have an important role in
cancer diagnostics, including the
identification of metastases from
primary tumours of the respiratory
system. Until recently, the more
expensive 3 T systems have been
used primarily for research, but
they are becoming increasingly
BG-09 MRI 6/8/07 20:54 Page 139
Table 1. 1.5 T and 3 T models evaluated.
GE
1.5 T Signa HDx Signa HDe
model
3T Signa HDx
model
popular for clinical work. They
offer the possibility of higher image
quality and shorter scanning times.
Hitherto, MRI has not been the
modality of choice for imaging the
respiratory system. The air content
in the lungs usually makes it
difficult to produce sufficient image
contrast at an appropriate spatial
resolution. Blurring can be present
in the images because of patient
motion and it can also occur because
the magnetic resonance signal from
the lungs decays very rapidly.
This article discusses the
technological features available on
the latest MRI systems that improve
image quality and imaging speed
and have enabled studies of lung
structure and function using MRI
[3]. These have included
examinations of blood flow in the
pulmonary vessels and blood
perfusion in lung tissue [4, 5].
Normally these studies are
performed with the use of injected
contrast agents. Respiratory gating
may be needed to coincide the
imaging with the patient’s
breathing. Such gating can reduce
motion blurring although ideally, if
the scan time can be reduced
enough, images can be acquired in
a single breath-hold.
Further developments are opening
up the potential for MRI to be used
MRI SCANNERS: A BUYER’S GUIDE
Philips Siemens
Intera Achieva MAGNETOM
Symphony
Achieva Allegra
X series
much more widely in the diagnosis
and management of respiratory
disease. These include inhaled gas
contrast agents (such as
hyperpolarised helium), which
enable MRI to track how air is
being used in the lungs [5, 6].
How does MRI work?
MRI provides excellent structural
and functional images of the soft
tissues, organs and vasculature in
any desired spatial plane. This is
achieved when the patient is placed
inside a powerful magnetic field.
Most modern scanners are based on
superconducting magnets, which
are cooled with liquid helium.
The billions of protons that
constitute the nuclei of hydrogen
atoms in the body have magnetic
properties. These continually spin
in different directions, but line up
with the pull of the main magnetic
field. Once the protons are spinning
in unison, they can all be tipped out
of their alignment with the main
magnetic field by applying a pulse
of energy in the radiofrequency
(RF) range. This is achieved with an
RF transmit coil that is normally
built into the scanner.
After the RF pulse has been
applied, the protons return to their
original positions, releasing energy in
THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
09
Toshiba
MAGNETOM Excelart
Avanto I Vantage
class & T class
Trio, A Tim
System
I class &
T class
the form of a signal, which carries
information about specific tissues.
The signal is collected by an RF
receive coil, a range of which are
provided for different areas of the
body. The pulse sequences, which
describe a pattern of pulses, are
designed to provide differing image
contrast for different body tissues,
such as the brain or the heart.
Three further coils built into the
scanner, known as the gradient
coils, are switched rapidly on and
off during the scan. The magnetic
fields applied by the gradient coils
vary with position, encoding the
signal with spatial information so
that an image can be constructed.
The timing of the RF and gradient
pulses, and conversion of the
signals into images, is controlled by
computer.
Design features
The latest ranges of cylindrical
models have been designed with
patient comfort in mind, offering
wider flared openings to the
cylinder, shorter scan lengths, and
less acoustic noise.
Higher specifications usually mean
better-quality images and/or
reduced scan times, plus the ability
to perform the most advanced
applications. But it might be that
139
BG-09 MRI 6/8/07 20:54 Page 140
09 MRI SCANNERS: A BUYER’S GUIDE
not all the various pulse sequence
packages that come with these
models are required. Inevitably,
higher-specification machines also
tend to be more expensive.
However, these options could be
worth considering, as it may be
easier to add on further
applications as the technology and
clinical need develop.
All models come with certain
standard features. These include:
• A set of core pulse sequence
packages to cover the entire
anatomy. The higher-specification
models have a range of optional
additions for specific
applications, such as
spectroscopy (see below).
• A suite of RF coils to cover the
entire anatomy: head, body,
shoulder, spine coils, etc.
Key purchasing factors to
consider
1. Technical features
The strength of the main magnetic
field will affect image quality and
the number of applications for
which the scanner can be used. For
instance, advanced neurological
imaging techniques, such as
diffusion MRI, are normally
performed at 1.5 T and above. Low
field systems can produce images of
excellent diagnostic quality for
many applications. However in
general, the higher the strength, the
better will be the quality of the
images produced, because a higher
magnetic field provides a higher
signal-to-noise ratio. It should be
noted, however that the magnetic
resonance signal from lung may
decay even quicker at higher fields,
so any benefit may not be realised
unless the imaging time can be
reduced further through the use of
more powerful gradient coil
systems.
The signal-to-noise ratio (SNR) is
the most important parameter
defining image quality in MRI. A
low SNR means that the contrast
between different tissues can be
140 THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
obscured by background noise. On
the other hand, a high SNR provides
more options. For example, it can be
partially traded off to obtain
improved spatial resolution (smaller
pixels and finer detail) or faster
images through parallel imaging.
Faster scanning reduces the amount
of blurring caused by movement
during breathing.
Field uniformity and stability are
important for a good-quality image.
Good magnetic field homogeneity
over a large volume, which is
reflected in a large maximum field
of view, means that image quality is
maintained even on the peripheral
areas of the body. Sometimes the
high signal from fat tissue will need
to be suppressed, because it can
obscure important detail in the
image. This can be achieved using
special pulse sequences but it may
not be successfully suppressed if
magnetic field homogeneity is poor.
Homogeneity is normally defined
as the variation in magnetic field in
parts per million over a defined
spherical volume.
Shim coils, which produce a
relatively small current, readjust the
disturbance to the magnetic field
caused by the patient inside the
scanner, a process called active
shimming. The gradient coils are
used for active shimming, but
optional dedicated shim coils may
also be available. Field uniformity
and stability are even more
important for spectroscopy, which
analyses chemical information at
the molecular level and is primarily
used in oncology.
The radiofrequency system refers
to the number of independent
channels that can receive signals
from the RF coils. Multichannel RF
coils feature several receiving
elements, each of which can feed
into an independent channel in the
system. A higher number of
channels boosts the SNR and offers
the option of parallel imaging. A
higher SNR could be useful for lung
imaging, where there is more air
than tissue. Multichannel body coils
are likely to be the most important
component for this application.
Gradient coil systems provide the
images in any desired plane
(figure 1). The magnetic field
gradient applied by the coil is
measured in mT·m-1 while the rate
at which the gradient can be
changed, the slew rate, is
measured in mT·m-1·ms-1. Higher-
amplitude gradients, which can be
switched on and off quickly (high
slew rate) offer a stronger gradient
pulse within a shorter time frame.
This provides the same or even
better spatial resolution for a
shorter scan time. Various imaging
parameters can be selected to
determine the timings of the RF
and gradient pulses. For instance,
the repetition time, defined as the
time between successive RF
pulses, affects image contrast and
scan time. Since the MR signal
from lung tissue decays rapidly
short time-imaging parameters are
often essential. High-specification
gradients are needed for this.
Parallel imaging techniques use
information from the RF coils to
help spatially encode the magnetic
resonance signal, thus reducing the
number of times that the gradient
coils have to be switched on and
off, and speeding up the imaging
process. Various commercial
packages are available. The factor
by which the scan time is reduced is
known as the parallel imaging
factor. A factor of 2 will suit most
applications. This technique is
widely used in breath-hold
imaging. But higher parallel
imaging factors reduce SNR, so
higher-order factors have not been
used widely in clinical practice to
date. Multichannel coils are
required for parallel imaging.
2. Ease of use and safety
Patient comfort: about one in 10
patients feel claustrophobic inside
the closed cylinder and models with
wider apertures can help minimise
this. Wider, longer tables will
accommodate heavier patients,
which may become more important
if the prevalence of obese patients
continues to rise. Large RF coils are
quite heavy and some models
incorporate spine coils built into the
BG-09 MRI 6/8/07 20:54 Page 141
patient couch. Some also allow all
the coils to be plugged in at once,
which speeds up the process for
both patient and staff.
Safety: MRI equipment has a good
safety profile. Most adverse
incidents are the result of incorrect
procedures or are related to the
design of the MRI site. Active
shielding curbs the extent of the
fringe magnetic field around the
scanner, while built-in limits in the
scanner protect the patient from
excessive RF energy.
Ferromagnetic objects, such as
oxygen cylinders, can be sucked
into the main magnetic field and so
present a projectile hazard. It’s also
important to check whether patients
and staff have implants, metal pins,
or pacemakers.
Noise levels can exceed 100 dB,
although some models now feature
noise-control technology that
reduces this to <90 dB for most
scans. Hearing protection is essential
for patients and for staff remaining
in the scan room during imaging.
Dimensions: MRI scanners take up
a lot of space because of the need to
allow for the extent of the magnetic
field, and the heavier models may
require the floor to be reinforced.
Manufacturers specify the
minimum installation area, but if
space is constrained, large amounts
of magnetic field shielding may be
required to prevent the fringe field
from extending into public areas.
Compatibility with other existing
equipment needs to be checked to
ensure it is safe to use near the
scanner and that it will not
interfere with the images. Normally
there are safe operating conditions
that must be followed: for instance,
certain equipment may be safe only
if kept a certain distance from the
magnet.
3. Costs
Capital outlay: you can expect to
pay a minimum of £700,000
MRI SCANNERS: A BUYER’S GUIDE
Y
Z X
Figure 1. MRI gradient directions X, Y and Z.
(€1 million) for a 1.5 T model and
from £1 million (€1.5 million) for a
3 T model. Some level of service
and on-site training should be
included in this price.
Manufacturers will sometimes
include accessories in the overall
bundle of costs, but these can
vary, so check which accessories
are included. Manufacturers can
offer various financial packages.
Accessories include an independent
workstation, which allows you to
view images and perform image
processing away from the main
console. Other accessories you may
require include: contrast injectors,
cardiac, respiratory and oxygen
monitors, additional beds and
detachable trolleys. If these are not
included in the package, you need
to consider where you are going to
source them.
Similarly, check what sequence
packages are included, and
whether these suit your clinical
needs. What RF coils are included
and what come as optional
extras? Do you need to buy extra
RF channels to use some of
these coils?
Maintenance: high-specification
machines are expensive to buy
THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
09
and run. The liquid helium in the
magnet slowly boils off and it
will need to be topped up every
few years. What type of service
contract will you get? A 6-month
service is common and
frequently included in the price,
but check. Are there options to
extend it? How much will these
cost?
Before you buy: as well as reading
the brochures and talking to the
manufacturers, it is always worth
visiting the factory or a site where
your selected equipment is already
in use before you buy.
4. Customer support
Training: when the equipment is
installed by the manufacturer,
training on how to use it will
automatically be provided. Check
how much training will be
provided and for whom, and
whether this suits your needs. For
instance, you may need extra
training if you are upgrading from
a 1.5 T to a 3 T model. Will all the
training be on site?
Operator and reference manuals:
will these be provided in
electronic or print format, or
both?
141
BG-09 MRI 6/8/07 20:54 Page 142

09 MRI SCANNERS: A BUYER’S GUIDE

Table 2. Technical specifications for 1.5 T equipment.

GE Signa GE Signa Philips Philips Siemens Siemens Toshiba Excelart
HDx HDe Intera Achieva Symphony Avanto Vantage
Main magnetic <0.27 <0.27 0.35 0.2 0.4 0.2 <1.0
field
homogeneity
(40 cm DSV
ppm)
Max field of 480 480 530 530 500 500 500
view mm (isotropic) (isotropic) (isotropic) (isotropic) (isotropic) (isotropic) (isotropic)
For Atlas ZGV:
550 for x & y
directions and
500 for
z direction
Min field of 10 10 5 5 5 5 5
view mm
Helium refill >3 yrs >3 yrs 3 yrs 3 yrs 2 yrs 10 yrs 2–3 yrs
Min installed <33 <22 30 30 30 ≤30 28.8
area m2
RF system EXCITE HDx EXCITE HDe Synergy Freewave Advanced/ TM AGV/XGV/
Whole body 32x8/76x18/ ZGV/Atlas
Array 76x32
No of 8/16/32 4/8 4/6 8/16/32 Advanced=4 8/18/32 AGV=4
independent Whole body=8 XGV=4,8
RF receiver ZGV=8
channels Atlas=16
Gradient HDx Twin HDe Pulsar Pulsar Nova Nova Quantum Q SQ AGV XGV ZGV
system HP HP Dual engine engine
HP
Max amplitude 33 50 23 33 33 33 33,66 30 33 40 30 30 33
mT·m-1 X, Y, Z (45 Z)
Slew rate 120 150 50 80 100 180 180, 90 125 125 200 50 130 200
mT·m-1·ms-1
X, Y, Z
Min TR ms 3D 1.2 1.2 1.7 2.25 1.07 0.83 0.83 1.8 1.8 1.5 3.5 3.5 3.5
gradient echo

DSV: defined spherical volume; RF: radiofrequency; TR: repetition time.

Table 3. Technical specifications for 3 T equipment.

GE Signa HDx Philips Achieva Siemens Allegra Siemens Trio
X series
Main magnetic field 0.25 0.5 0.1 0.1
homogeneity (40 cm DSV ppm)
Helium refill 4 yrs NA 7 months 9 months
Minimum installed area m2 36 19 28 <33
RF system HDx Freewave iPAT/IPAT plus 102x8/102x18/102x32
No of independent RF 8 /16/32 8 /16/32 iPAT=4 102x8=81/102x18=18/
receive channels iPAT plus=8 102x32=32
Max amplitude mT·m-1 X, Y, Z 50 Standard mode = 40 40 40 (45 for z direction)
Enhanced mode = 80
Slew rate mT·m-1·ms-1 X, Y, Z 150 Standard mode = 100 400 200
Enhanced mode = 200
Min TR ms 3D gradient echo 1.2 1.1 1.72 1.6
Max field of view mm 450 (x & y directions) 530 (isotropic) 220 (isotropic) 500 (isotropic)
480 (z directions)
Min field of view mm 10 5 5 5

DSV: defined spherical volume; RF: radiofrequency; TR: repetition time.

142 THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS

BG-09 MRI 6/8/07 20:54 Page 143

MRI SCANNERS: A BUYER’S GUIDE 09

Table 4. Patient comfort: 1.5 T models.

GE Signa GE Signa Philips Intera Philips Siemens Siemens Toshiba
HDx HDe Achieva Symphony Avanto Excelart
Vantage
Patient 60x
x46.5 60x
x46.5 60x
x42 60x
x42 60x
x45.2 60x
x45.5 60x
x48.3
aperture at
narrowest cm
Width x height
(couch to pole)

Total length cm 195 195 167 167 160 160 149.5

Couch 97/69 97/69 89/52 89/52 100/45 89/47 87.5/42
max/min
height cm
Body mass 159 159 150 150 200 200 200
limit kg
DSV: defined spherical volume; RF: radiofrequency; TR: repetition time.

Table 5. Patient comfort: 3T models.

GE Signa HDx Philips Achieva Siemens Allegra Siemens Trio
X series

Patient aperture at 60x

x105 60x
x42 35x
x35 60x
x45.5
narrowest cm
Width x height
(couch to pole)
Total length cm 189 167 142 213
Couch max/min height cm 69/97 52/89 46/80 57/100
Body mass limit kg 159 150 200 200

Service contract: find out if there

are enough engineers to fix any
potential problems and how soon
the manufacturer guarantees to
rectify them. How widely available
are parts? How quickly can they be
shipped in? Does the manufacturer
guarantee a certain number of
working days in the year
(guaranteed ‘uptime’)?
Remote diagnostics: some
manufacturers operate remote
diagnostics, whereby the system is
automatically linked to the factory.
This can speed up detection and
resolution of problems. Check
whether this is available.
All CEP reports since 2002 are
available to download from the
organisation's website. An email
alert service is also available, by
contacting cep@pasa.nhs.uk ■
REFERENCES
1. NHS Purchasing and Supply Agency. Report 06006 3T MRI Systems. Issue 4. May
2007.
2. NHS Purchasing and Supply Agency. Report 06005 1.5T MRI Systems. Issue 7. May
2007.
3. Heidemann RM, Griswold MA, Kiefer B, et al. Resolution enhancement in lung 1H
imaging using parallel imaging methods. Magn Reson Med 2003; 49: 391–394.
4. Kluge A, Gerriets T, Lange U, Bachman G. MRI for short-term follow-up of acute
pulmonary embolism. Assessment of thrombus appearance and pulmonary perfusion:
a feasibility study. Eur Radiol 2005; 15: 1969–1977.
5. Mills GH, Wild JM, Eberle B, Van Beek EJR. Functional magnetic resonance imaging
of the lung. Br J Anaesth 2003; 91: 16–30.
6. Fain SB, Korosec FR, Holmes JH, et al. Functional lung imaging using hyperpolarized
gas MRI. J Magn Reson Imaging 2007; 25: 910–923.
MANUFACTURERS’ WEBSITES
Philips Medical Systems www.medical.philips.com
Siemens Medical Solutions www.medical.siemens.com
GE Healthcare www.gehealthcare.com
Toshiba Medical Systems (Europe) www.toshiba-europe.com/medical/

THE BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS 143