Selected Podcast
Tesla 7 - Research to Improving Clinical Outcomes
Blake Weis MD discusses Tesla 7 research to improving clinical outcomes. He identifies safety of 7T MRI. He compares 7T vs. other field strength MRIs s in terms of image quality and he introduces both indications and proposed indications of 7T MRI.
Transcription:
Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and in this exciting podcast today we're examining the Tesla 7 - Research to Improve Clinical Outcomes. Joining me is Dr. Blake Weis. He's a neuroradiologist at the Carle Foundation Hospital. Dr. Weis, I've been looking forward to this podcast. It's a pleasure to have you join us. So, tell for other providers, tell us what is the 7 T MRI? How and why did this come about?
Blake Weis, MD (Guest): Thanks for having me on guys. Basically what we have right now, is a 7 T magnet, which is a stronger magnetic field than we usually use with MRI. There's only about five clinical sites in the United States that are scanning patients at the hospital using this type of imaging technology. And it's really just one of the several new magnets that we have. We have a great fleet of magnets, but essentially to answer your question 7 T uses a stronger magnetic field and through obtaining better signal to noise ratio, we get better looking higher resolution images that can hopefully pick up more sensitive pathology, maybe even earlier. So we're very excited about it.
Host: Well, it certainly is exciting technology. So, I'd like you to speak about for what conditions it's most beneficial? Where are we right now at Carle with the 7 T? When should a provider order this and tell us the indications or proposed indications for this 7 T MRI?
Dr. Weis: Sure. Thanks. And that is a great question. Where we're at right now with Carle is we are scanning brains and knee joints. So, we're also giving contrast. We had to work around giving contrast a little bit because of such a high magnetic field, some of the code equipment, we, you know, safety is our number one priority. So, we've just recently started giving contrast. And right now what we're doing is for the most part we're scanning patients that have had a previous MRI at a 1.5 or a 3 T Tesla.
And the reason for that is because the technology is so new that we're trying to calibrate and tune our eyes to know what things are supposed to look like on this new magnetic field. So essentially we are scanning a lot of epilepsy patients that have had a 3 T previously Dr. Graham Houston has been giving us a lot of patients. We're also doing some kind of basic hospital work. Some strokes, some things as inpatients. That's basically where we're at right now. What's very exciting about the technology is that we're all going to be able to find out together here at Carle being kind of on the vanguard of where we go with it next. Establishing care. We have so many exciting research projects, but as we're just getting off the ground, that's what we're doing thus far.
Host: Well, thank you for that. And I think one of the things that other providers and certainly referring physicians are going to want to know is about safety considerations. Are there any you'd like to mention, and please help us to identify the safety of the 7 T MRI.
Dr. Weis: Sure. So I did want to talk about safety because again, that, that is our number one concern. And it's certainly a safe technology, but most of our MRIs these days are being done at 1.5 or 3 T Tesla. That's the strength of the magnetic field. This is 7 Tesla. So some things that start to come into play is that once you have a stronger magnetic field, we're going to have to more carefully select patients and just more carefully monitor who we're putting in the magnet. So, for example, there's a metric called SAR, S-A-R, and that is basically a measurement of how much heat deposition is placed into the soft tissue of a person's body. This is about four times greater using a 7 T magnet. That's not to say that it's unsafe.
It's just higher than it would be with a conventional MRI. Also some people can get tingling of the peripheral nerves, again, a benign process, but just things that can happen, that we need to prepare people for before they hop in the magnet. Also any sort of metallic implants are going to be under a greater magnetic field.
And what I mean by that is a hip replacement, any metallic you know, maybe foreign body, even. Essentially, we're just going to be a lot more meticulous about screening process. And just wanted to get across why we're doing that. Abandoned pacemaker leads are, more dangerous. And I also want to point out that there's something with an MRI called a Gauss line, where if you get within a certain distance of this line, pacemakers, cochlear implants, other items can become scrambled for lack of a better word by the magnetic field.
This magnetic field is so strong, that it actually isn't completely shielded inside the magnet. It actually goes into the control room. So I just wanted, since I know I'm talking to a lot of doctors out there if you have any of these items, we're going to be screening you too. We need to be careful who even gets close to the magnet at all, but I don't mean to scare anybody.
It's very safe. You just, these are just some of the increased safety precautions that I wanted to, I wanted to explain to everybody why the screening form is so extensive because we have to address these items.
Host: What great points you made. That was very comprehensive Dr. Weis. So now can you compare and contrast the 7 versus the other field strength MRIs? In terms of image quality, I mean, obviously we're thinking it's better. That's why it's there now, but tell us why it's better and what you like about.
Dr. Weis: Sure. So, the applications are almost endless. And this kind of builds into the question that you asked me before. Like where do I think, you know, we're going with this? Or, you know, when should we order? Again, that's why it's so exciting. It's not really established. It's a difficult question to ask because I can't give a doc. I know a lot of doctors are listening to this. You might say, can a 7 MRI see smaller intercranial metastasis before other MRIs so that we could treat them earlier. The answer to that is probably yes, but that has not been proven yet. And that's what we're going to be finding out together. What this is really good for right now is defining pieces of anatomy that we usually could not see or characterize very well in the brain.
So, subthalamic nuclei, the cochlea of the inner ear, mesial temporal lobes. I discussed earlier, a lot of times we're given epilepsy cases and we simply do not see an epileptic focus. With this increased signal to noise ratio, we're going to pick up more foci. We're going to do better for the patients.
Host: So before we wrap up, where do we think we'll be going from here in the foreseeable future? Tell us any exciting research projects that are going on that you'd like to share with other providers.
Dr. Weis: Oh, the partnership that we have with the Carle School of Medicine is outstanding. We have so many great projects going on. A few are coming to mind. So, there's exquisitely sensitive sequences for blood and calcification in the head and where that might come into play is post-concussive syndromes. I think about young athletes. I think about even I think about dementia, older patients. We're going to be able to see changes in the brain on an imaging standpoint, you know, at an earlier time period in the disease process. So for tiny micro hemorrhages from a concussion that right now I read an MRI on and I call it normal.
I don't see anything. We're probably going to be able to see new findings. Right now, when I look at again, I keep kind of mentioning seizure patients. I'm a little bit biased, cause I'm a neuroradiologist. So we're scanning a lot of those patients. Sometimes the mesial temporal lobe for mesial temporal sclerosis looks normal to me on our conventional MRI. The 7 T, you can simply see it a lot better. You can see the inner ear a lot better. I have no doubt that you can see or again, it's not established yet, but that we're going to be able to pick up, I want to talk about the knee a little bit, subtle meniscal tears, subtle ligamentous tears that you know, you just simply cannot see on current imaging.
I do want to say that the 7 T is not going to completely replace other field magnets as we've discussed. Not everyone can get one. And I don't want people to feel as though they need a 7 T right now to be fully evaluated. We have several great new magnets, including 3 T and 1.5 T magnets.
This is just going to be another powerful tool in our toolbox. And if I wanted to drive one point home, it's that you know, we're going to be collaborating with other centers and we're going to be figuring this out together because these guidelines don't really currently exist.
Host: Do you have any parting thoughts that you'd like to leave other providers with about the exciting technology we've been discussing today?
Dr. Weis: Sure, I do. I've spent a lot of my life the greater part of a decade studying about MRI and CT. And the only reason I bring that up is it's quite, it can be quite confusing. Sometimes even I'm still a little confused. So, despite the stereotype that radiologists like to hang out in the dark by themselves. My colleagues, Dr. Jason Houston, Dr. Douglas Morton and myself, just give us a call if there's a question about what to order or if a 7 T would be right for a certain patient. If not, what kind of protocol should we do? What do we think about something? We're very happy to answer anyone's questions and make sure we get the right imaging for everyone.
Host: What an interesting podcast this was. Thank you so much, Dr. Weis for joining us and telling us about this exciting technology. And that concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com or for more information and to get connected with one of our providers, you can always go to carle.org. I'm Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and in this exciting podcast today we're examining the Tesla 7 - Research to Improve Clinical Outcomes. Joining me is Dr. Blake Weis. He's a neuroradiologist at the Carle Foundation Hospital. Dr. Weis, I've been looking forward to this podcast. It's a pleasure to have you join us. So, tell for other providers, tell us what is the 7 T MRI? How and why did this come about?
Blake Weis, MD (Guest): Thanks for having me on guys. Basically what we have right now, is a 7 T magnet, which is a stronger magnetic field than we usually use with MRI. There's only about five clinical sites in the United States that are scanning patients at the hospital using this type of imaging technology. And it's really just one of the several new magnets that we have. We have a great fleet of magnets, but essentially to answer your question 7 T uses a stronger magnetic field and through obtaining better signal to noise ratio, we get better looking higher resolution images that can hopefully pick up more sensitive pathology, maybe even earlier. So we're very excited about it.
Host: Well, it certainly is exciting technology. So, I'd like you to speak about for what conditions it's most beneficial? Where are we right now at Carle with the 7 T? When should a provider order this and tell us the indications or proposed indications for this 7 T MRI?
Dr. Weis: Sure. Thanks. And that is a great question. Where we're at right now with Carle is we are scanning brains and knee joints. So, we're also giving contrast. We had to work around giving contrast a little bit because of such a high magnetic field, some of the code equipment, we, you know, safety is our number one priority. So, we've just recently started giving contrast. And right now what we're doing is for the most part we're scanning patients that have had a previous MRI at a 1.5 or a 3 T Tesla.
And the reason for that is because the technology is so new that we're trying to calibrate and tune our eyes to know what things are supposed to look like on this new magnetic field. So essentially we are scanning a lot of epilepsy patients that have had a 3 T previously Dr. Graham Houston has been giving us a lot of patients. We're also doing some kind of basic hospital work. Some strokes, some things as inpatients. That's basically where we're at right now. What's very exciting about the technology is that we're all going to be able to find out together here at Carle being kind of on the vanguard of where we go with it next. Establishing care. We have so many exciting research projects, but as we're just getting off the ground, that's what we're doing thus far.
Host: Well, thank you for that. And I think one of the things that other providers and certainly referring physicians are going to want to know is about safety considerations. Are there any you'd like to mention, and please help us to identify the safety of the 7 T MRI.
Dr. Weis: Sure. So I did want to talk about safety because again, that, that is our number one concern. And it's certainly a safe technology, but most of our MRIs these days are being done at 1.5 or 3 T Tesla. That's the strength of the magnetic field. This is 7 Tesla. So some things that start to come into play is that once you have a stronger magnetic field, we're going to have to more carefully select patients and just more carefully monitor who we're putting in the magnet. So, for example, there's a metric called SAR, S-A-R, and that is basically a measurement of how much heat deposition is placed into the soft tissue of a person's body. This is about four times greater using a 7 T magnet. That's not to say that it's unsafe.
It's just higher than it would be with a conventional MRI. Also some people can get tingling of the peripheral nerves, again, a benign process, but just things that can happen, that we need to prepare people for before they hop in the magnet. Also any sort of metallic implants are going to be under a greater magnetic field.
And what I mean by that is a hip replacement, any metallic you know, maybe foreign body, even. Essentially, we're just going to be a lot more meticulous about screening process. And just wanted to get across why we're doing that. Abandoned pacemaker leads are, more dangerous. And I also want to point out that there's something with an MRI called a Gauss line, where if you get within a certain distance of this line, pacemakers, cochlear implants, other items can become scrambled for lack of a better word by the magnetic field.
This magnetic field is so strong, that it actually isn't completely shielded inside the magnet. It actually goes into the control room. So I just wanted, since I know I'm talking to a lot of doctors out there if you have any of these items, we're going to be screening you too. We need to be careful who even gets close to the magnet at all, but I don't mean to scare anybody.
It's very safe. You just, these are just some of the increased safety precautions that I wanted to, I wanted to explain to everybody why the screening form is so extensive because we have to address these items.
Host: What great points you made. That was very comprehensive Dr. Weis. So now can you compare and contrast the 7 versus the other field strength MRIs? In terms of image quality, I mean, obviously we're thinking it's better. That's why it's there now, but tell us why it's better and what you like about.
Dr. Weis: Sure. So, the applications are almost endless. And this kind of builds into the question that you asked me before. Like where do I think, you know, we're going with this? Or, you know, when should we order? Again, that's why it's so exciting. It's not really established. It's a difficult question to ask because I can't give a doc. I know a lot of doctors are listening to this. You might say, can a 7 MRI see smaller intercranial metastasis before other MRIs so that we could treat them earlier. The answer to that is probably yes, but that has not been proven yet. And that's what we're going to be finding out together. What this is really good for right now is defining pieces of anatomy that we usually could not see or characterize very well in the brain.
So, subthalamic nuclei, the cochlea of the inner ear, mesial temporal lobes. I discussed earlier, a lot of times we're given epilepsy cases and we simply do not see an epileptic focus. With this increased signal to noise ratio, we're going to pick up more foci. We're going to do better for the patients.
Host: So before we wrap up, where do we think we'll be going from here in the foreseeable future? Tell us any exciting research projects that are going on that you'd like to share with other providers.
Dr. Weis: Oh, the partnership that we have with the Carle School of Medicine is outstanding. We have so many great projects going on. A few are coming to mind. So, there's exquisitely sensitive sequences for blood and calcification in the head and where that might come into play is post-concussive syndromes. I think about young athletes. I think about even I think about dementia, older patients. We're going to be able to see changes in the brain on an imaging standpoint, you know, at an earlier time period in the disease process. So for tiny micro hemorrhages from a concussion that right now I read an MRI on and I call it normal.
I don't see anything. We're probably going to be able to see new findings. Right now, when I look at again, I keep kind of mentioning seizure patients. I'm a little bit biased, cause I'm a neuroradiologist. So we're scanning a lot of those patients. Sometimes the mesial temporal lobe for mesial temporal sclerosis looks normal to me on our conventional MRI. The 7 T, you can simply see it a lot better. You can see the inner ear a lot better. I have no doubt that you can see or again, it's not established yet, but that we're going to be able to pick up, I want to talk about the knee a little bit, subtle meniscal tears, subtle ligamentous tears that you know, you just simply cannot see on current imaging.
I do want to say that the 7 T is not going to completely replace other field magnets as we've discussed. Not everyone can get one. And I don't want people to feel as though they need a 7 T right now to be fully evaluated. We have several great new magnets, including 3 T and 1.5 T magnets.
This is just going to be another powerful tool in our toolbox. And if I wanted to drive one point home, it's that you know, we're going to be collaborating with other centers and we're going to be figuring this out together because these guidelines don't really currently exist.
Host: Do you have any parting thoughts that you'd like to leave other providers with about the exciting technology we've been discussing today?
Dr. Weis: Sure, I do. I've spent a lot of my life the greater part of a decade studying about MRI and CT. And the only reason I bring that up is it's quite, it can be quite confusing. Sometimes even I'm still a little confused. So, despite the stereotype that radiologists like to hang out in the dark by themselves. My colleagues, Dr. Jason Houston, Dr. Douglas Morton and myself, just give us a call if there's a question about what to order or if a 7 T would be right for a certain patient. If not, what kind of protocol should we do? What do we think about something? We're very happy to answer anyone's questions and make sure we get the right imaging for everyone.
Host: What an interesting podcast this was. Thank you so much, Dr. Weis for joining us and telling us about this exciting technology. And that concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com or for more information and to get connected with one of our providers, you can always go to carle.org. I'm Melanie Cole. Thanks so much for listening.