The FONAR UPRIGHT® Multi-Position™ MRI is not just for claustrophobic patients.
Unfortunately, the overwhelmingly positive responses from patients to the extraordinary patient-friendly environment of the scanner, especially claustrophobic and very large patients, can overshadow the scanner’s most important feature – Multi-Position MRI imaging.
The UPRIGHT® MRI is the only MRI scanner than can scan patients in any position, including sitting, standing, bending (for flexion and extension) or lying down. This unmatched feature is made possible by the scanner’s unique magnet configuration. With the opposing magnetic poles oriented vertically, the generous space between them accommodates a special motorized patient bed that can rotate the patient from recumbent to upright.
Dramatically Different From All Other MRIs
The magnetic field strength of the FONAR UPRIGHT® Multi-Position™ MRI is 0.6 Tesla. At 0.6 Tesla, it is categorized as a “Mid-Field” MRI. Most “Open” MRIs (all of them recumbent-only scanners) operate at 0.3 Tesla.
Many equate magnetic field strength to image quality – the higher the field, the better the image. All other things being equal, that is a fair statement. In fact, however, all other things are not equal, meaning that in comparing one MRI to another, field strength is only half of the story.
The magnetic configuration of the UPRIGHT® MRI is dramatically different from all other MRIs, both High-Field MRIs and so-called “Open” MRIs. As a result, the UPRIGHT® MRI is able to use both solenoid and planar RF receiver coils. No other MRI can do this.
This explains why the UPRIGHT® MRI’s 0.6 Tesla images are competitive with 1.5 Tesla High-Field MRI images. Here is the explanation of why the magnet configuration of the UPRIGHT® MRI is advantageous:
A Fundamental Principle of MRI:
The RF receiver coil achieves maximum sensitivity when its axis of symmetry (yellow arrow) is perpendicular (90 ) to the direction of the magnetic field (green arrows).
The UPRIGHT® MRI has a unique magnet design, which allows it to employ this principle in two ways. The patient is positioned between two vertical poles so that the magnetic field transverses the body in the left-right direction (green arrows) This unique design allows both flat planar and solenoid (“wrap- around”) coils to be used separately or in combination (in quadrature).
The UPRIGHT® MRI Can Use Flat Planar Coils (just like High-Field MRIs) :
The red circle represents a flat planar coil.
A flat planar coil is used for a lumbar spine scan.
The UPRIGHT® MRI Can Use Solenoid (“Wrap-Around") Coils (which High-Field MRIs can’t):
A solenoid (“wrap-around”) coil is used for a cervical spine scan.
Advantages of The Fonar Upright® Multi-Position™ MRI
Symptom–Specific Positional Scanning
Only the FONAR UPRIGHT® Multi-Position™ MRI can scan patients in the positions in which they experience problems —sitting, standing, bending, leaning, as well as lying down. All other MRIs can only scan patients lying down. The UPRIGHT® MRI enables the patient to place himself in the position that generates the pain so that images can be acquired in that very position. Correctly identifying the pain-generating pathology can markedly improve patient surgical outcomes. In addition, it enables the surgeon to see all the pathology he has to address, not just the single-position, non-weight-bearing image provided by the conventional MRI. This enables the surgeon to see the full extent to which the disk herniation increases when the patient flexes or extends, or the extent to which the patient's vertebra is sliding back and forth with body position.
Scanning With the Weight of The Body on the Spine and Other Joints
The UPRIGHT® MRI allows all parts of the body to be imaged with the normal weight of the body on the spine and other joints—an advantage that can lead to a more accurate diagnosis. Imaging the spine when it is fully loaded with the weight of the body, as compared to unloaded in a conventional lie–down MRI, is critical to an accurate diagnosis. As you can see from case studies, the source of back problems can be “missed” when the spine is not bearing the weight of the body and not imaged in the positions the spine normally occupies.
Cerebrospinal Fluid Flow (CSF) Studies (Works-in-Progress)
The UPRIGHT® MRI is able to visualize and identify the dynamic obstructions of cerebrospinal fluid (CSF) flow. Such obstructions may be playing a role in the genesis of multiple sclerosis. Visualization of a causative CSF flow obstruction and a careful image analysis of it could lead to treatments or surgical remedies that might be helpful to overcome this pathology.
UPRIGHT® MRI technology is particularly potent in this context, as it provides upright, multi-position images of the fully-weight-loaded cervical spine as well as multi-position "movies” of the CSF surrounding the spinal cord. “Movies” showing spinal fluid moving in and out of the upright spinal canal in all of its normal upright body positions (as well as recumbent) and into the brain can provide critical diagnostic information.
Correlated Slice Protocol (CSP)
CSP (correlated slice protocol) technology enables the reading radiologist to view a side-by-side comparison of each slice of the scan in all of the positions the slice occupies (including recumbent). CSP technology enables the radiologist to report to the surgeon precisely which image slices were the most problematic for the patient throughout the patient's full range of motion. The surgeon can view them and choose the best surgical procedure for fully restoring a pain-free normal range of motion to the patient’s spine.
There are a growing number of patients who are sustaining dislocations of the cervical spine from automobile collision whiplash injuries of the head and neck. The UPRIGHT® MRI is needed to assess the extent to which the brain has been dislocated [descent of the tonsils of the cerebellum] into the opening in the bottom of the skull (foramen magnum). This critical assessment of the extent of brain herniation into the opening at the base of the skull (cerebellar tonsil ectopia, or CTE) can only be determined with the patient in the upright position so that the surgical repair of this herniation and the patient's "drop attacks" can be eliminated.
Special Patient Needs
Some patients are unable to lie down for an MRI exam, including kyphotic patients or hospitalized patients with congestive heart failure. In the absence of UPRIGHT® MRI, these patients would be unable to receive the MRI examinations they need.
The UPRIGHT® MRI routinely accommodates large patients, many who simply did not fit into any other MRI. Our patient bed can handle patients weighing up to 500 pounds.
Patients with scoliosis, which most commonly arises for the first time in young adolescent girls, have been reported by the National Cancer Institute to experience a 70% higher incidence of breast cancer as adults than the non-scoliotic population.1 The increased incidence is attributed to the multiple annual chest x-rays (2-3 times per year) needed to monitor the child's scoliosis until adulthood in order to assure satisfactory treatment. The UPRIGHT® MRI provides the same necessary vertebral angle ("Cobb angle") measurements as the x-ray (plus the needed measurements of vertebra rotation not supplied by x-ray), thereby avoiding routine x-ray exposure.
1“Breast Cancer Mortality After Diagnostic Radiography: Findings from the U.S. Scoliosis Cohort Study,” Michele Morin Doody, John E. Lonstein, Marilyn Stovall, David G. Hacker, Nicolas Luckyanov, and Charles E. Land, Spine, Aug. 15, 2000, Vol. 25, No. 16.
Pelvic Floor Dystrophy (PFD)
Women patients, as a result of the inherent trauma of childbirth to their pelvic floor anatomy, will commonly suffer the consequences of PFD later in life. The symptoms of PFD are cystic prolapsed ("falling urinary bladder") and its chronic cystitis symptoms of urinary frequency, burning on urination, fever, and if unaddressed, chronic kidney inflammation (pyelonephritis). The patient must be upright to see it. It commonly returns to its normal position when the patient is recumbent and therefore is not diagnosed by the patient's physician who examines her in the recumbent position. It affects 10 million women. The UPRIGHT® MRI readily visualizes the fallen bladder when these patients are upright, so that the surgeon has full image visualization of the anatomy that has to be repaired.