Earlier this year, a coalition of experts polled imaging departments across the U.K. to discover the state of magnetic resonance (MR) machines in the National Health Service (NHS).

The Clinical Imaging Board (CIB) – a collaboration between The Royal College of Radiologists, the College of Radiographers and the Institute of Physics and Engineering in Medicine – revealed half of healthcare organizations do not have set machine renewal plans, and more than a third of older magnetic resonance (MR) imaging scanners are not scheduled for replacement.

While many hospitals are operating newer equipment, 58 percent of MR systems used by those surveyed were at least five years old, meaning they may not be able to conduct state-of-the-art imaging, such as that needed for certain types of heart and prostate cancer scanning. Nearly a third (29 percent) of U.K. systems are over 10 years old.

In addition, these aging MR scanners are also set to do even more work, with departments estimating their workload is set to rise by at least 13 percent over the coming year.

Following the survey, CIB members were quick to call on hospitals and health chiefs to formulate clear plans to replace outdated equipment.

HealthCare Business News spoke to the leads at each CIB member organization to discover just what this aging equipment base means for doctors, radiographers and medical physicists on the ground, as well as their patients.

Dr Nicola Strickland, consultant clinical radiologist at Imperial College Healthcare NHS Trust, president of The Royal College of Radiologists and chair of the Clinical Imaging Board.

NHS imaging departments are conducting more than 3 million magnetic resonance (MR) scans every year. The technique is more time-consuming and expensive than most other scans, but it is a vital imaging method for investigating a whole range of different types of disease, including assessing patients with neurological and cardiac problems, looking for subtle bone diseases and tracking cancer, and demand is only set to keep growing.

The fact that nearly a third of public MR scanners are older than the maximum 10-year life span recommended by the European Society of Radiology is, sadly, not a surprise. As many are aware, our health service is under ongoing financial strain.

However, U.K. hospitals must prioritize and plan for new equipment, for our patients’ sakes.

The greater computing power and more sophisticated software of newer MR scanners means that radiologists can get much more diagnostic information from scan images, information which is crucial in improving patient care. For example, patient movement artifacts can be corrected, body organs such as the liver can be analyzed for their content of damaging fat and iron and the beating heart can be imaged.

Only newer MR scanners can scan the whole body in one go, enabling reliable detection of the spread of cancer around the body, or a complete and accurate analysis made of bony destruction in bone marrow diseases, such as multiple myeloma. The early use of whole-body MR scans also enables rapid and accurate assessment of the response of these diseases to treatment when compared with subsequent follow-up scans, and is far more sensitive than any other type of imaging modality.



Dr Martin Graves, consultant clinical scientist at Cambridge University Hospitals NHS Foundation Trust and Institute of Physics and Engineering in Medicine Fellow

MR physicists are key members of the multidisciplinary team responsible for delivering many aspects of an MR service in the NHS. Their remit can include MR safety, facility design and quality management. Particularly relevant to an aging equipment base are the challenges of effective service delivery and protocol optimization. The hardware and software limitations of older systems often mean that it is impossible to implement many of the techniques that are rapidly becoming the standard of care (e.g. multi-parametric imaging of the prostate or whole-body imaging.) Furthermore, older systems are often unable to take advantage of new technical developments that can increase patient throughput.

Although the CIB survey did not find a notable relationship between reported levels of system reliability and age, it is more challenging for the system vendors to maintain and repair older systems. This applies equally to the ancillary equipment that is required to keep an MR system fully operational, such as cold-water chillers that are often not adequately maintained. Part of the physicist’s role may be to help troubleshoot the resultant image artifacts and system errors and work with the vendors to determine the root cause of imaging failures and system downtime.

The 2017 NHS cyberattack also highlighted the challenges of maintaining the security of medical devices. Older MR systems may be based on unsupported computer operating systems that can no longer be appropriately patched or secured. Again, it may be the MR physicist’s responsibility in the organization to identify these risks and work with hospital IT staff to try and mitigate against them.


Charlotte Beardmore, director of professional policy at the College of Radiographers

Not replacing aging MR scanners raises a variety of issues, all of which have a negative effect on patient care. Consistent and progressive investment means that service users benefit from the latest technology, which has enhanced diagnostic capabilities, as well as providing a more efficient and cost-effective service.

Older equipment is prone to downtime, parts are more difficult to replace and safety may be compromised. There is enough stress in modern health care without the added uncertainty of when the scanner will break down and play havoc with patient waiting times and increasing demand.

At a time when shortages of qualified and experienced practitioners are becoming more acute, recruitment and retention are key. A department or facility which can show that there is ongoing investment to replace outdated technology is more likely to attract and keep the best talent. Sickness absence caused by stress and frustration is also less likely.

Commissioners are more inclined to source services that show a commitment to investment and progressive practice.

The key to maintaining a first-class MR service for patients is constant planning and investment in both equipment and personnel for the short, medium and long term.