Question 1: Rationale and Comparative Advantages
The technology behind PET-MRI presents a major stride in terms of nuclear medicine. Since the inception of nuclear medicine as a discipline, the overall medical domain has received a huge boost in terms of precision in diagnosis and treatment (Boss at al., 2010). However, the PET-MRI is the most recent advancement in this field and is promising to impact on medicine in a very positive manner. The contemporary world is faced by a myriad of intricate health conditions that require an equally sophisticated approach. It is the technologies such as the PER-MRI that hold the key to the 21st century medicine. PET-MRI is a hybrid imaging technology that utilizes both the PET functional imaging and the MRI soft tissue technologies. In terms of feasibility, this technology promises major prospects in the field of medicine. The knowledge of functional anatomy is instrumental to medicine.
Evidence has revealed that when the PET and MRI technology are used separately, their efficiency is relatively lower. As such an incorporation of the technologies is pretty feasible in medicine. Although PET-CT is an equally important discovery and has for the last few decades enhanced imaging, diagnosis and treatment, PET-MRI is a comparatively superior combination. Multimodality imaging is becoming an increasingly embraced medical technology, and demand is very high (Pichler et al., 2010). This implies that the time aspect must be factored. PET-CT is time-consuming and may not provide a whole-body image.PET-CT depends on the ionization to conduct imaging, and the X-ray dose of the PET-CT depends on the material examination protocol. Different examination protocols require different levels of X-ray dosages and exposure. Taking this fact into consideration, it becomes impossible for the PET-CT technology to be used for whole-body imaging. The PET and MRI technologies in many occasions use different machines, and this can be time-consuming. Multimodality modality imaging saves time and unlike the single modality applications, it is possible for a patient to have a single appointment with the doctor. On the other hand, PET-MRI provides more elaborate and aligned images and has a comparative advantage when it comes to surgical planning.
In terms of precision, resolution, clarity and time, there is enough clinical justification to replace the CT with MRI.
As a warm-up to adopt the replacement of PET-CT with PET-MRI, nuclear scientists should start learning this new technology (Pichler et al., 2010). PET-MRI marriage is convincingly a more feasible marriage than the PET-CT due to the several comparative benefits that accrue to it. Most contemporary health challenges lie with the field of diagnosis and the PET-MRI technology proves to be a better diagnostic tool compared to the separate use of PET and MRI, especially in the field of neuroscience and understanding of the neurological disorders. The PET-MRI technology will offer new insights to neuroscience. It fosters a good understanding of the brain function, oxygen consumption, brain metabolism and perfusion. The accurate and temporal co-registration of information will foster the attribution of both molecular and functional information of the tiny brain parts or structures (Boss at al., 2010). It will be possible to understand the correlation between the brain perfusion and uptake of local radiotracer. Time-dependent aspects such as the perfusion alterations characteristic to stroke patients may largely rely on the concurrent establishment of PET perfusion and diffusion-weighted imaging and to find out the optimal therapy formula.
Apart from the neuroscience field, oncological studies present another field that is set to receive a major boost by the PET-MRI marriage (Buchbender et al., 2012). Various experiences by the oncologists show that this technology is comparatively effective when compared to other precedent technologies. PET/MRI allows them to detect a wider variety of malignant areas with more confidence, efficiency and accuracy. As a result, this provides a better and reliable monitoring of cancer growth and planning the therapeutic interventions (Buchbender et al., 2012)
Question 2: Skills and Capabilities
Emergence of new technologies should be accompanied by the acquisition of new skills. It means that the introduction of the PET-MRI technology in clinical settings will call for the development of new skills by clinicians. Since the comparative benefits of this technology have been confirmed, it is important to inculcate the new skills and knowledge relevant to this technology for the nuclear science medics. Every new technology present new threats to the patient and the success of the PET- MRI depend on how the clinicians will manage to minimise threats while at the same time maximizing its utility. This implies that knowledge to deal with future threats to both the patients and the users is imperative. The MRI utilizes static magnets, and this may present a challenge to the clinicians who were not accustomed with it (Pichler et al., 2010).
As such, it will be important to understand the working of the static magnet and the diagnosis of sensory effects associated with the static magnet such as taste sensations and nausea. Different classes of patients have different reactions to magnetic fields. Therefore, it would be important to understand the effect of the magnetic fields on the various classes of patients. For instance, use of magnetic fields affects patient suing cochlear and penile implants. Use of protective devices is the solution to the apparent effects of the magnetic fields on patients using cochlear or penile implants. Therefore, learning should focus on enhancing a thorough understanding of how to use these protective gears and devices to protect these patients.
The Larmor equation and use of graphs to analyze data will become an integral when the use PET-MRI becomes widespread. It is important to possess skills in using the equation and subsequently undertaking accurate graphical analysis. Other skills and capabilities that will be important include; knowledge of the Net Magnetism Vectors, resonance of the hydrogen atom, Faraday’s law of induction and various specific radioactivity laws and concepts.
Question 3: Designing the syllabus
As with any other new technology, the adoption of PET/MRI requires several specific skills that will avert the dangers of this technology to the patient and the physician who utilizes the technology. At the same time, there is a level of knowledge and skills required to operate the PET/MRI so that the healthcare personnel can ensure full optimization of this technology and as such improve outcomes. However, the most critical aspect is to ensure safety during utilization. There are several issues that the physician must take into account in relation to safety of the patient and the full optimization of the PET/MRI (Medical Radiation Practice Board of Australia, 2010). These include;
- The heating up of the pacemakers, artificial limps and any other implanted devices as a result of the embedded magnet during examination may lead to further losses and escalation of pain and complications (Medical Radiation Practice Board of Australia, 2010). Ideologically, it is wise to monitor such metals and devices to prevent the occurrence of situations that may end up heating the metals. If these metals or devices are deemed prone to heating from the effect of the embedded magnet, the best solution is to utilize any other methodology or perform the PET/MRI only on a specific portion (Australian Institute of Radiography, 2010).
- Loose metal objects may lead to further damage of the existing devices or treatment options especially where metallic objects are embedded (Medical Radiation Practice Board of Australia, 2010). As such, knowledge of dealing with static magnetic field emanating from the magnet is deemed crucial.
- Usually, some patients may receive some sensory reactions related to the static magnetic field. The ability to deal with such patient sensory reactions should not be overlooked at any cost.
- The duration of exposure to the PET/MRI scan radio waves should be moderated to avoid body warming that could result to alteration of body tissue and organ dysfunction. However, the exposure effect varies from one patient to another and thus the clinician must make a thorough analysis of the patient history to ascertain what duration is suitable. Similarly, the moderation techniques, especially voltage and current levels to avoid body warming are critical skills for the clinician conducting the PET/MRI scan.
- The diversity of the patient who may require PET/MRI calls for proper assessment. Thus the clinician should take time to analyze issues such as pregnancy and any implanted medication which may later the results of the scan or cause further injury and complications (Medical Radiation Practice Board of Australia, 2010). On a similar note, the clinician must possess the ability and skills to implant protective devices such as pacemakers, cochlear and penile implants (Australian Institute of Radiography, 2010).
- The hydrogen atom acts as the baseline upon which the clinician makes decisions regarding the PET/MRI scan. As such, knowledge of the action and reaction of the hydrogen atom when subjected to the magnetic field should be administered to the users. This should go hand in hand with the ability to make accurate interpretations of the hydrogen atom nucleus spinning and motion while in the magnetic field.
- The proper alignment of the protons depends on the strength of the field. At all extremities, these protons may not achieve the desired anti-parallel alignment which essentially gives the Net Magnetization Vector (NMV). Thus, applicable knowledge on the variation of the field strength to achieve the NMV is important when using the PET/MRI (Australian Institute of Radiography, 2010).
- Physical interpretation of the hydrogen atom motions in the magnetic field should be accompanied by the ability to apply the Larmor equation. This will facilitate the making of accurate precisions of the hydrogen atom spins as well as the occurrence of the hydrogen atom resonance.
- The PET/MRI technology revolves around the radioactivity physics. As such, knowledge regarding the relaxation of the T1 and T2 in MRI systems as well as the role of proton density in determining contrast in the imaging is important. On the other hand, operational skills to adjust the T1, T2 and the proton Density so as to achieve the desired pulse sequence and images should be administered to the clinician (Australian Institute of Radiography, 2010).
- As with any other system, the ability to interpret, analyze and preset the information acquired from the system is crucial so as to enable the clinician make logical conclusions. As such, mathematical/graphical skills to determine the spatial encoding in relation to the gradient coils are important for the user or clinician (Australian Institute of Radiography, 2010).
- The ability to understand and interpret the K-space relies heavily on the user’s knowledge of the MRI operational aspects. This should be combined with a wide knowledge of physical, mathematical skills to deduce relevant and applicable knowledge of the spatial resolution (Australian Institute of Radiography, 2010).
References
Australian Institute of Radiography. (2010). Australian Institute of Radiography: MRI STUDY GUIDE .
Boss, A., Bisdas, S., Kolb, A., Hofmann, M., Ernemann, U., Claussen, C. D., & Stegger, L. (2010). Hybrid PET/MRI of intracranial masses: initial experiences and comparison to PET/CT. Journal of Nuclear Medicine, 51(8), 1198-1205.
Buchbender, C., Heusner, T. A., Lauenstein, T. C., Bockisch, A., & Antoch, G. (2012). Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. Journal of Nuclear Medicine, 53(8), 1244-1252.
Medical Radiation Practice Board Of Australia. (2010). Professional capabilities for medical radiation practice. Medical Radiation Practice Board Of Australia, 1-16.
Pichler, B. J., Kolb, A., Nägele, T., & Schlemmer, H. P. (2010). PET/MRI: paving the way for the next generation of clinical multimodality imaging applications. Journal of Nuclear Medicine, 51(3), 333-336.
