A simple MRI protocol tweak at one hospital system is netting big savings while also opening more slots for exams, according to a new study.

In 2010, more than 7 million Americans had total replacements of their hips or knees, a number that will only grow as the population ages. These patients come with special considerations when undergoing magnetic resonance imaging, given that their implants can potentially damage the exam’s diagnostic usefulness.

University Hospitals recently confronted this issue in its own Cleveland-based institution, according to a study published March 22 in Current Problems in Diagnostic Radiology [1]. An inordinate number of patients with metallic hardware were receiving inappropriate MRIs without a key sequence to reduce any related artifacts.

However, the institution has recently undergone a quality-improvement project to begin systematically steering patients to the right machines.

“Given that 11.4 million Americans are anticipated to have either a knee or hip replacement by 2030, wide implementation of protocols such as this have the potential to save both time and money for patients and the medical system,” Nathan Amann, with Case Western Reserve University School of Medicine, and co-authors concluded. “We therefore recommend the adoption of this protocol at other institutions.”

For the study, researchers queried University Hospitals’ PACS system seeking individuals with metal artifacts who had received an MRI between 2020-2021. This netted a total of 244 cases that met the study criteria, which radiologists analyzed to assess the diagnostic quality and whether the proper imaging system was used.

University Hospitals then implemented a protocol change in August 2021. It included providing education on the advantages of using metallic artifact reduction sequences, or MARS, to image such patients. They also discussed the downsides of 3T MRI, and how it may produce even more pronounced artifacts due to its stronger magnetic field. The health system operates a total of 29 imaging sites running 34 MRI machines; however, only 14 of its locations have systems equipped with MARS, the authors noted.

With the new protocol, University Hospitals flagged any MR imaging orders that contained terms such as “metal suppression.” Schedulers then steered patients to the proper sites that offered MARS and away from those with 3T scanners. They also posted a document on the departmental website, outlining the correct sites for treating this population, among other changes.

Analyzing a post-intervention group of 78 more patients demonstrated early success. Prior to the protocol, only 55% of patients received MRI using metal artifact suppression sequences, which leapt to 69% afterward. Meanwhile, about 6% underwent imaging using the 3T scanner, a number that fell to 1% after the update.

About 17% of exams were considered “nondiagnostic” and unusable before the fix, but providers reduced the total down to 5%. Amann et al. highlighted potential cost savings after the switchover. The 41 unusable exams netted a cost of $9,714, while the four in the post-intervention group tallied $1,083 in costs. Based on their calculations, this would yield an average savings of about $25.92 per exam. And with about 11,640 musculoskeletal MRIs performed at University Hospitals each year, the numbers start to add up.

“With the anticipated rise in the number of patients presenting with metallic hardware and the ever-growing demand for MRI, there is a need to optimize the system to promote cost and time savings,” the authors advised.