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Yale neurologist share first-hand experience with scanning patients positive for the virus.
Clinical evidence continues to grow over the neurological and vascular complications that develop with COVID-19 infection. While identifying these problems can be critical to offering optimal patient care – and in some situations – potentially helping avert long-term debilitation, moving patients who test positive for the virus presents several problems. Many are too sick to be moved, and transporting a patient to a stationary MRI presents an increased risk of viral transmission.
To address these concerns, a handful of hospitals nationwide have begun using Hyperfine, a portable MRI system that conducts head scans at the patient’s bedside. Diagnostic Imaging spoke with Kevin Sheth, M.D., professor of neurology and neurosurgery and director of the neuroscience ICU at Yale School of Medicine, about how his department is using these machines. He shared his thoughts on the benefits, challenges, limitations, and impact of bedside MRI.
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Palmer: In the context of COVID-19, what role can bedside MRI play, and why is it so important when it comes to treating these patients?
Sheth: The first thing I would say is that this is very early – the use of this kind of a system in a pandemic. It’s very important not to accidentally overreach. There'll be a huge temptation on the part of a lot of different people to get very excited. There is a lot of reasonable excitement, but match that with not being too superlative about it.
I do think the pandemic highlights what we’d normally be thinking about rural settings or Third World settings. There’s clear opportunity to have a portable MRI system right where you might not be able to do intracranial imaging. The setting of COVID-19 you have, first of all, just widespread pandemic and, then, you have patients that are in ICUs that are oftentimes very sick and unstable to move for diagnostic imaging. In patients that are sedated, oftentimes, you're not getting neurological exams of any kind for days. They're in medically-induced comas, and you have no way to look clinically or radiographically as to what's going on inside the brain.
So, in that context, it varies probably from hospital to hospital. In some places you can still get a CT scan or an MRI scan. But, other places, you can't, and if you can, it's usually a big production. It’s very difficult and not necessarily safe for patients to move. And, at all hospitals, there's certainly a subset of these patients in the intensive care unit that are just too unstable to move. That premise shows you that there is a need. There is a gap that something could fill if something could provide sort of meaningful intracranial imaging. Then, if we look at a device like the portable MRI, it's a natural place to jump in and fill in that gap because you bring the portable device to the patient as opposed to moving a sick patient to the device. You can do so in the routine clinical setting right in the ICU room. So, that's the opportunity.
We started imaging some patients with COVID-19 that are in our intensive care units just like this. In that sense, I think it's very, very helpful.
Palmer: Given that you have used this with patients, what has your experience been? What are you seeing when you bring the system to the patient and have that chance to see intracranially?
Sheth: I think at this level, no one should or could make too many statements about what they're seeing, because that's a small number of cases so far, whether it's here or anywhere else. What we can do, though, with some reassurances is rule out things on might be relatively obvious to see on a CT scan or a conventional MR, like a brain hemorrhage or a large stroke or if there was some kind of very diffuse swelling or hydrocephalus or things like that. We’ve imaged a couple of patients that have had known pathology from conventional scans previously that we could recapitulate and see on the portable device. That was reassuring, and it also told us that those pathologies had not changed over time. So, that's helpful information. I think in other situations, you might see a normal scan, and even knowing that is, you know, helpful to an extent.
Palmer: Alongside the clinical impact, given that COVID-19 has presented a litany of other concerns when it comes to via transmission and safety or other dangers, what is it about having a bedside MRI that may help you navigate those issues?
Sheth: I think about helps, and it both, and it also raises new issues. It helps in the sense of not moving these patients around the hospital on multiple floors, not going to areas where a lot more patients might be going that are not are not affected with COVID-19, including MRI suites, CT scanning suites. You’re not taking them on and off the table. You have a lot more exposure to both equipment and people if you have to move people. When you can bring a device into the room, at least you can limit some of that exposure. So that's helpful.
It does mean, analogous to other devices that you would take into a room like a portable chest X ray machine or an ultrasound device or any other device, is that now when you take something in and out of a room, it is something extra that you're taking in and out of the room. You have to be mindful about how to clean that. You don't want the virus jumping from the patient to the portable device, only for you to move the portable device to another room. What we've done is we've had a dedicated device that's only for COVID patients. That way, at least if you're going from room-to-room, both patients have COVID anyway. So, you're not sort of increasing the transmission. We've had multiple devices at Yale, and we have a dedicated COVID device and a dedicated non-COVID device.
Palmer: As you said, we're very early in using bedside MRI in general, and, then, particularly with COVID-19 patients, but how would you describe the impact that it's had so far on your ability to provide care? Are there a couple of takeaway messages?
Sheth: I would say the biggest takeaway message is No.1, that being able to perform meaningful intracranial imaging during a pandemic and, in general, for critically ill patients in a way that COVID-19 highlights has today been a huge monitoring gap. There's a need, there's a huge need here. That's what the pandemic highlights, especially from a neurological perspective. But the second thing, is that a solution, like the portable MRI, and our ability to scan patients successfully, shows that this kind of method is feasible and is certainly an important and viable approach. The next step is just pushing the conversation that we're having about how do we get now in that context, enough meaningful experience that we can show that it can also drive decision making and monitoring. But, in terms of processing feasibility, I think our experience shows that we can.
Palmer: Wonderful. All right. Well, thank you so much for taking the time. I do appreciate it.
Sheth: My pleasure. Thanks so much.