Rapid-sequence, Unsedated, Non-contrast MRI for Acute Musculoskeletal Infection Workup
Grant Recipient: Romie Gibly, MD, PhD
- Institution:
- Lurie Children's Hospital
- Additional Information:
- When we submitted this grant in late 2020, Jonathan Samet MD (co-investigator in the Department of Radiology) and I were in the early phases of developing a rapid-sequence, unsedated and noncontrast MRI imaging protocol. Since receipt, the project has gone through two phases:
During the first 6 months of 2021, we continued to optimize the imaging parameters, sequences, and scan times to maximize image quality and minimize scan times. Initially, trial sequences were added onto existing infection MRI’s to compare image quality. There was a large amount of discussion between our radiologists on the appropriate level of detail and establishing reading expectations for the images. Once we had developed the sequences and felt comfortable with the image quality, we spent a significant amount of time preparing for deployment across the hospital. This included educational sessions with the emergency department, infectious disease, orthopaedic surgery and hospitalist teams. We developed an inclusion algorithm and appropriate use criteria and worked with the media team to deploy it in the emergency department (see attached) as well as create appropriate EPIC EMR ordersets.
The Rapid MSK infection MRI protocol officially deployed in July, and since then we have collected almost 40 studies. We have continued to work on ensuring appropriate use and integrated the protocol into our institutions new musculoskeletal infection clinical care guideline (CCG). We have compared these initial 6 months of patients and images to a set of traditional MRIs obtained for MSK infection evaluation from 2019. Although data analysis and appropriate statistical analysis are currently ongoing (along with additional sample collection), the results have been very exciting. In brief, we went from about 50% of patients getting anesthesia to about 6%. None of the rapid patients received contrast (previously almost 90% did). The time from MRI order to MRI start went from an average of 571 min to 173 min with the rapid protocol (P<0.05). The MRI itself went from an average of 77 minutes to 27 minutes. The length of hospital stay also improved by over a day as well. Data was unfortunately not ready in time for submission to the POSNA 2022 conference.
We have achieved our goal, although significant work remains. We will continue acquiring data on new studies. We are involving a statistician to help with ensuring rigor of our analysis. We continue to finalize chart review. We have not yet been able to obtain cost/charge information from the hospital as this is a complex process at our institution.
The preliminary data will be presented as a poster at ORS and will be submitted to additional conferences this year as opportunities become available. We anticipate at least 2 publications being submitted. One with a radiologic focus on the techniques and deployment, and a second orthopaedic publication looking at use and outcomes. Further success will hopefully encourage other institutions to develop similar imaging protocols to expedite pediatric musculoskeletal infection workups.
Rapid MSK Infection Workflow Handout
