Open or Upright MRI Scanning

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. A standard MRI scanner is a large tube that contains powerful magnets. The patient normally lies inside the tube during the scan

Conventional MRI

Conventional MRI is established as the most sensitive imaging test of choice of the spine in routine clinical practice.

MRI imaging of the spine is performed to:

• Assess the spinal anatomy
• Visualize anatomical variations and diseased tissue in the spine
• Assist in planning surgeries on the spine such as decompression of a pinched nerve
• or spinal fusion
• Monitor changes in the spine after an operation, such as scarring or infection
• Guide the injection of steroids to relieve spinal pain
• Assess the disks, (i.e. bulging, degenerated or herniated intervertebral disk, a
• frequent cause of severe lower back pain and sciatica)
• Evaluate compressed (or pinched) and inflamed nerves
• Explore possible causes in patients with back pain (compression fracture for
• example)
• Image spinal infection or tumours that arise in, or have metastasized to, the spine
• Assess children with daytime wetting and an inability to fully empty the bladder

The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion–extension, in the erect position or by using axial loading

Axially Loaded MRI

A modification of conventional MRI, known as axially loaded MRI, has been developed

Axial loading refers to the application of a force on a subject’s body to simulate weight- bearing

For this technique, patients put on a special harness that compresses the spine while they lie in the MRI scanner, but this procedure may not accurately reproduce the weight-bearing state

Positional MRI (Upright MRI)

Positional MRI has been developed to provide images of the spine under true weight- bearing conditions

This technique relies on a vertically open configuration MRI scanner in which the circular magnets have been turned on end

The patient sits or stands between the magnets during image collection and can adopt various positions such as flexion or extension of the neck or back, allowing imaging of the spine under conditions that occur in daily life

Standing or sitting MRIs may be performed with patients in different positions (eg. extension, flexion, neutral) for comparison of anatomy in various positions

Current Upright MRI (uMRI) scanners generally use medium field magnets of 0.5T or 0.6T. By comparison, the most advanced standard MRI scanners have magnet strength of at least 1.0T and up to 3.0T allowing for the greatest resolution generally in a shorter amount of time. With 0.6T magnets, uMRI requires more time to obtain images with lower resolution

Slower imaging times with uMRI may create difficulty for the following groups of patients if:

• Unable to remain still while in a standing or sitting position
• Experiencing pain or discomfort whilst in an upright position
• Instability in such upright positions

Longer exam times may also decrease the overall patient flow and volume of patients that can be accommodated

The proposed advantages of uMRI are based on the ability to scan the spine (or joints) in different positions (including the position where clinical symptoms are more pronounced) and assess the effects of weight bearing, position and dynamic movement

Referral

A completed prior approval referral form will need to be received by the ICB IFR Team before the procedure is requested

Using secure email, please send the completed prior approval referral form to cwicb.ardenifr@nhs.net

The ICB Individual Funding Request Team will provide a decision to you within 5 working days

Eligibility Criteria

Referral for open MRI scanning of at least 0.5T as an alternative to conventional MRI in is subject to prior approval where the patient meets the following:

• Have claustrophobia where an oral prescription sedative has not been effective (flexibility in the route of sedative administration may be required in paediatric patients as oral prescription may not be appropriate) AND/OR
• Obese and cannot fit comfortably in conventional MRI scanners as determined by a Consultant Radiologist/Radiology department policy AND/OR
• Cannot lie properly in conventional MRI scanners because of severe pain despite adequate analgesia provision AND/OR
• Require load bearing MRI images to be undertaken AND
• There is a clear diagnostic need consistent with supported clinical pathways

IN ADDITION, The ICB will only fund uMRI of the specific anatomy requested

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB