The role of MRI in diagnostics, prognostics, and discoveries in basic sciences has been well established. However, access to this life-saving technology is largely restricted to countries in upper-middle to high-income groups. In this article, we collate recent global MR scanner density data and group them into six geographical regions based on the WHO classification. We then analyze these data with respect to demographic factors such as population size, life expectancy, the percentage of internet users, and World Bank income grouping. We map these demographic factors to five dimensions or characteristics of accessible MRI, adapting definitions from the healthcare literature. With this background, the study then reviews recent demonstrations of accessible MRI categorized based on main magnetic field strength. We describe demonstrated examples for each of these categories, ranging from ultralow-field to ultrahigh-field MRI. Lastly, we review MR methods and associated developments impacting accessible MRI such as increasing/augmenting MR awareness and local expertise, incorporating hardware-cognizant methods, rapid quantitative imaging, and leveraging innovations from adjacent fields. Level of Evidence: 5 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.

Accessible magnetic resonance imaging: A review.

Access to scanners for magnetic resonance imaging (MRI) is typically limited by cost and by infrastructure requirements. Here, we report the design and testing of a portable prototype scanner for brain MRI that uses a compact and lightweight permanent rare-earth magnet with a built-in readout field gradient. The 122-kg low-field (80 mT) magnet has a Halbach cylinder design that results in a minimal stray field and requires neither cryogenics nor external power. The built-in magnetic field gradient reduces the reliance on high-power gradient drivers, lowering the overall requirements for power and cooling, and reducing acoustic noise. Imperfections in the encoding fields are mitigated with a generalized iterative image reconstruction technique that leverages previous characterization of the field patterns. In healthy adult volunteers, the scanner can generate T1-weighted, T2-weighted and proton density-weighted brain images with a spatial resolution of 2.2 × 1.3 × 6.8 mm3. Future versions of the scanner could improve the accessibility of brain MRI at the point of care, particularly for critically ill patients. A portable prototype scanner for brain MRI that uses a compact and lightweight permanent rare-earth magnet with a built-in readout field gradient generates clinically relevant images of the brain, as shown in adult volunteers.

A portable scanner for magnetic resonance imaging of the brain.

Purpose To develop a highly efficient magnetic field gradient coil for head imaging that achieves 200 mT/m and 500 T/m/s on each axis using a standard 1 MVA gradient driver in clinical whole-body 3.0T MR magnet. Methods A 42-cm inner diameter head-gradient used the available 89- to 91-cm warm bore space in a whole-body 3.0T magnet by increasing the radial separation between the primary and the shield coil windings to 18.6 cm. This required the removal of the standard whole-body gradient and radiofrequency coils. To achieve a coil efficiency ~4× that of whole-body gradients, a double-layer primary coil design with asymmetric x-y axes, and symmetric z-axis was used. The use of all-hollow conductor with direct fluid cooling of the gradient coil enabled ≥50 kW of total heat dissipation. Results This design achieved a coil efficiency of 0.32 mT/m/A, allowing 200 mT/m and 500 T/m/s for a 620 A/1500 V driver. The gradient coil yielded substantially reduced echo spacing, and minimum repetition time and echo time. In high b = 10,000 s/mm2 diffusion, echo time (TE) 50% reduction compared with whole-body gradients). The gradient coil passed the American College of Radiology tests for gradient linearity and distortion, and met acoustic requirements for nonsignificant risk operation. Conclusions Ultra-high gradient coil performance was achieved for head imaging without substantial increases in gradient driver power in a whole-body 3.0T magnet after removing the standard gradient coil. As such, any clinical whole-body 3.0T MR system could be upgraded with 3-4× improvement in gradient performance for brain imaging.

Highly efficient head-only magnetic field insert gradient coil for achieving simultaneous high gradient amplitude and slew rate at 3.0T (MAGNUS) for brain microstructure imaging.

PURPOSE
Distortions in magnetic resonance imaging (MRI) compromise spatial fidelity, potentially impacting delineation and dose calculation. We characterized 2D and 3D large field of view (FOV), sequence-independent distortion at various positions in a 1.0 T high-field open MR simulator (MR-SIM) to implement correction maps for MRI treatment planning.


METHODS
A 36 × 43 × 2 cm(3) phantom with 255 known landmarks (∼1 mm(3)) was scanned using 1.0 T high-field open MR-SIM at isocenter in the transverse, sagittal, and coronal axes, and a 465 × 350 × 168 mm(3) 3D phantom was scanned by stepping in the superior-inferior direction in three overlapping positions to achieve a total 465 × 350 × 400 mm(3) sampled FOV yielding >13 800 landmarks (3D Gradient-Echo, TE/TR/α = 5.54 ms/30 ms/28°, voxel size = 1 × 1 × 2 mm(3)). A binary template (reference) was generated from a phantom schematic. An automated program converted MR images to binary via masking, thresholding, and testing for connectivity to identify landmarks. Distortion maps were generated by centroid mapping. Images were corrected via warping with inverse distortion maps, and temporal stability was assessed.


RESULTS
Over the sampled FOV, non-negligible residual gradient distortions existed as close as 9.5 cm from isocenter, with a maximum distortion of 7.4 mm as close as 23 cm from isocenter. Over six months, average gradient distortions were -0.07 ± 1.10 mm and 0.10 ± 1.10 mm in the x and y directions for the transverse plane, 0.03 ± 0.64 and -0.09 ± 0.70 mm in the sagittal plane, and 0.4 ± 1.16 and 0.04 ± 0.40 mm in the coronal plane. After implementing 3D correction maps, distortions were reduced to <1 pixel width (1 mm) for all voxels up to 25 cm from magnet isocenter.


CONCLUSIONS
Inherent distortion due to gradient nonlinearity was found to be non-negligible even with vendor corrections applied, and further corrections are required to obtain 1 mm accuracy for large FOVs. Statistical analysis of temporal stability shows that sequence independent distortion maps are consistent within six months of characterization.

Technical Note: Characterization and correction of gradient nonlinearity induced distortion on a 1.0 T open bore MRâ SIM

Stroke is a leading cause of death and disability worldwide. The reasons for increased stroke burden in developing countries are inadequately controlled risk factors resulting from poor public awareness and inadequate infrastructure. Computed tomography and MRI are common neuroimaging modalities used to assess stroke with diffusion-weighted MRI, in particular, being the recommended choice for acute stroke imaging. However, access to these imaging modalities is primarily restricted to major cities and high-income groups. In the case of stroke, the time-window of treatment to limit the damage is of a few hours and needs a point-of-care diagnosis. A low-cost MR system typically achieved at the ultra-low- and very-low-field would meet the need for a geographically accessible and portable solution. We review studies focused on accessible stroke imaging and recent developments in MR methodologies, including hardware, to image at low fields. We hypothesize that in the absence of a formal, rapid stroke triaging system, the value of timely on-site delivery of the scanner to the stroke patient can be significant. To this end, we discuss multiple recent hardware and methods developments in the low-field regime. Our review suggests a compelling need to explore further the trade-offs between high signal, contrast, and accessibility at low fields in low-income communities. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 6.

Low-Field MRI of Stroke: Challenges and Opportunities.

Purpose To build and evaluate a small-footprint, lightweight, high-performance 3T MRI scanner for advanced brain imaging with image quality that is equal to or better than conventional whole-body clinical 3T MRI scanners, while achieving substantial reductions in installation costs. Methods A conduction-cooled magnet was developed that uses less than 12 liters of liquid helium in a gas-charged sealed system, and standard NbTi wire, and weighs approximately 2000 kg. A 42-cm inner-diameter gradient coil with asymmetric transverse axes was developed to provide patient access for head and extremity exams, while minimizing magnet-gradient interactions that adversely affect image quality. The gradient coil was designed to achieve simultaneous operation of 80-mT/m peak gradient amplitude at a slew rate of 700 T/m/s on each gradient axis using readily available 1-MVA gradient drivers. Results In a comparison of anatomical imaging in 16 patients using T2 -weighted 3D fluid-attenuated inversion recovery (FLAIR) between the compact 3T and whole-body 3T, image quality was assessed as equivalent to or better across several metrics. The ability to fully use a high slew rate of 700 T/m/s simultaneously with 80-mT/m maximum gradient amplitude resulted in improvements in image quality across EPI, DWI, and anatomical imaging of the brain. Conclusions The compact 3T MRI system has been in continuous operation at the Mayo Clinic since March 2016. To date, over 200 patient studies have been completed, including 96 comparison studies with a clinical 3T whole-body MRI. The increased gradient performance has reliably resulted in consistently improved image quality.

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Christopher Van Epps

Papers

Lightweight, compact, and high-performance 3T MR system for imaging the brain and extremities