SimonMed Imaging CEO discusses why his radiology practice offers elective whole-body MRIs
One debate that continues to stir strong opinions across the radiology community is the use of full-body MRI screenings. Some radiologists see it as a vital tool for early disease detection, but others believe it as an expensive and potentially anxiety-inducing procedure that offers more questions than answers.
John Simon, MD, CEO of SimonMed Imaging—one of the largest outpatient imaging and radiology providers in the U.S.—firmly believes the answer lies in the data. And after more than two decades of offering whole-body MRI screenings, he says the case is stronger than ever for making these scans more accessible. He spoke with Radiology Business on the topic in the video above.
"We have probably the largest series of whole-body imaging in the world, or close to it. We've been doing it over 20 years. We have a very specialized radiology practice, we have high quality readers and we use two specialists to read. We do very detailed sequences. And with all that, we looked at our statistics and our detection rate is higher than most other screening technology out there. It's significantly higher than screening mammography, higher than virtual colonoscopy or colonoscopy. In terms of other screening technology, we pick up more cancers," Simon explained.
He said questions come up at meetings and conferences he attends about the clinical value of these patient-elected, out-of-pocket MRI screenings.
"I would challenge most practitioners, would you rather treat something early or would you rather treat it late? And what are the better odds of survival? Some people you'll never convince, but I believe the facts are on our side. And I think over time as more and more individuals have the exam and it's helpful to them, the truth will permeate through where it'll be viewed positively," Simon said.
A look inside the whole-body scanning programs
Whole-body MRI screenings are noninvasive imaging exams that take a comprehensive look at the body's major organ systems without the use of radiation or contrast agents. Originally requiring over an hour to complete, recent advancements in AI, scanner technology, and image acquisition, such as compressed sensing and deep learning-based image reconstruction, have reduced scan times to under 15 minutes, depending on the sequences used.
SimonMed’s current price for the scan is $495, which Simon acknowledges is still a barrier for many patients, but a considerable drop from the $2,000-plus typically charged by other providers. The company also reduced its rate recently because new technologies have made the exam much faster to administer and review.
“We’ve always made affordability a priority. This isn’t a big profit center for us, but we do it because it saves lives,” Simon explained.
The scans are reviewed by two specialized radiologists—typically a neuroradiologist and a body radiologist—ensuring thorough evaluation. Additionally, physician assistants or nurse practitioners consult directly with patients to explain findings, alleviating anxiety and ensuring clarity around next steps.
“Just delivering a report isn’t enough,” Simon said. “Patients need to understand what we found, what it means, and what to do next.”
MRI is good for many things, but some imaging modalities are better for specific clinical questions. For this reason, supplemental imaging with other modalities like CT also will be offered for whole-body MRI patients.
Critics raise concerns about whole-body screenings
Not all radiologists are on board with whole-body MRI screenings. Some professionals question the necessity of scanning asymptomatic individuals from head to toe. Concerns include the potential for false positives, over diagnosis, unnecessary follow-ups, and patient anxiety, which are common drawbacks in any type of screening program. These exams also are viewed by many as high-end, concierge access healthcare for the rich.
Simon is aware of these critiques but remains unshaken. He said patients who seek these exams are being proactive to try and catch diseases earlier in their progression, when they are easier to treat. For cancers, heart disease and developing aneurysms that are found, Simon said they are often discovered on these scans years before they patient would have become symptomatic. In most cases, proactive patients opting for these scans want to have a more comprehensive "look under the hood" to better understand their health and monitor for early signs of disease, rather than waiting for symptoms to appear, as is the current model of care.
"Over 20 years, we've refined the technique and the whole idea of screening overall. There are new categories really for almost everything we do. We know how to identify findings that are high probability of malignancy or require action, and ones that don't. So, as long as patients are informed that this is a screening study and they understand we're trying to pick things up early. There will be some findings that are going to be benign, but we'll need to track them to confirm that," Simon explained.
AI is helping speed exam times
SimonMed integrates state-of-the-art artificial intelligence tools into both the scanning equipment and the image interpretation process. AI built into the newer scanners and image reconstruction algorithms have greatly reduced scan times. Some AI algorithms also are used to help with interpretation, including automation of quantifying various findings.
"It's really a whole new generation of AI tools that all the major manufacturers are coming out with. In terms of AI interpretation, we do integrate AI tools in the interpretation for our whole-body exams," Simon said. "The AI tools we use for some protocols, such as looking for neuro quantification, and looking for early Alzheimer's changes in asymmetric volume loss. And for our cardiac screening we use tools from either HeartFlow, Cleerly and Elucid to look for plaque analysis. So we're seeing the AI tools really aid on the diagnostic side with the radiologists, and it's more of an enhancement. We're seeing more than what we could see just by a radiologist alone."
Whole-body screening impacts real lives
Simon shared several anecdotes of instances where the screenings detected serious conditions in asymptomatic individuals.
Often patients forget to add family history details that could be used in verbal patient screenings, but the imaging can go beyond what a patient may recall when answering seemingly unrelated questions about long-deceased family members. One notable case involved a volunteer who was found to have a life-threatening intracranial aneurysm, despite initially reporting no relevant family history or symptoms. But when they found an aneurysm in the whole-body MRI and asked the patient, she recalled a grandparent who died early in life from an aneurysm.
"Patients don't always give a full history. It's a stressful situation when you come in for an exam. You don't always think that the history is relevant. But the beauty of the MRI is you get a clear viewpoint of everything," Simon said.
In a series of screenings SimonMed performed for firefighters, its providers found an increased incidence of renal cell cancers and offered them early warning, which otherwise would have been overlooked until they became symptomatic. Even in younger patients, Simon said they find a surprising number of medical issues that were diagnosed very early.
"We have had dramatic findings with all kinds of cancers, whether it's thyroid cancer ovarian cancer, or even lung cancers. In neurological findings, we can see a lot of things very early and now there are drugs to treat a lot of these conditions if they are caught early enough. The aneurysm cases also are always very satisfying," Simon explained.
The mid-level providers who work with patients on a daily basis believe the whole-body screenings have been overwhelmingly positive.
"It's surprising how many cancers we've detected. And this is done, I believe, in a very thoughtful and responsible way. So we have proper followup. But in that sense, I don't see how you can deny the technology. It is just there to save lives," Simon explained.