0:00

So, really important if you're thinking

0:03

about this, I'm going to give you some

0:04

tips now for implementation, is how fast

0:07

is fast when you're really doing it.

0:11

How fast, how efficient are you? So here expected

0:15

times, full protocol is around 26 minutes.

0:18

Abbreviated is about 8.6.

0:19

9 00:00:20,165 --> 00:00:22,384 This is what we do at Penn,

0:23

including diffusion, which is a long

0:24

study, and you can see, as I alluded to

0:27

earlier, the T2 STIR is the long way.

0:29

It takes about 4 minutes the way we do it.

0:31

Now, there are ways to shorten that,

0:33

but this is what we do right now.

0:35

Um, so total scan time and when we measured

0:38

this, and we published this, um, actually,

0:40

um, I should, I don't think I have the

0:43

right reference down there, but and,

0:44

um, and, uh, we have published this in

0:47

the Journal of Academic Radiology.

0:49

Anyway, um, total scan time

0:52

expected scan time is the sum of the

0:54

acquisition times from each series.

0:56

The actual scanning part, the actual

0:58

scan time is what did it really

1:00

happen based on the DICOM times?

1:02

You know, when you pull up the images.

1:04

When did it really start and

1:05

when did it really finish?

1:05

We wanted to see how efficient we were. Total

1:08

scan times again, opening to closing the

1:10

exam in RIS, that's the technologist and the

1:13

technology activity times, the total scan time

1:16

minus the actual scan times, and then we divided

1:18

it into scan-related activities and non-scans.

1:21

We're really trying to be efficient

1:23

so we can get the full bang for

1:25

the time and the investment.

1:27

So process map, sorry, it's a little geeky,

1:30

but basically the patient arrives. An MRI,

1:33

these are external things.

1:35

The tech opens it in RIS,

1:36

escorts the patient to the room.

1:38

She has to position the patient,

1:41

starts the scan, plans slices, runs a scan,

1:44

processes images in scan, offloads patient,

1:47

patient leaves, tech closes study on RIS.

1:51

And so we have these external, um, and

1:53

other times that we have to look at

1:55

their non-scan related activities, which

1:57

are the blue boxes. The scan-related

2:00

activities are actually when she's dealing.

2:02

The technologist is helping the patient.

2:04

And then the actual scanning

2:05

time is the yellows.

2:07

That's the real active

2:08

time where you're imaging.

2:10

So let's look what happened.

2:13

We looked at the abbreviated

2:14

protocol and we did this early.

2:16

We only had 70 versus full protocol.

2:19

And if you look at our sequences,

2:21

that abbreviated MR should be 8.

2:23

6 minutes, right?

2:24

And the full should be around 26.

2:26

When we looked at the DICOM

2:28

headers, what were the time?

2:28

Whoa, 17.

2:29

5 minutes versus 28.

2:33

That's not much of a difference in the

2:34

full protocol, but what's going on in

2:36

the abbreviated protocol, total scan

2:40

time and opening, closing the wrists.

2:42

They're getting pretty similar.

2:43

Tech activity time, very similar, even

2:46

though they're less sequences, significantly

2:48

fewer sequences on the abbreviated protocol.

2:51

Scan related activities, very

2:53

high for the abbreviated protocol.

2:56

Non scan related activities as well.

2:58

What's going on?

2:59

Why are our fast protocols not so fast?

3:03

We weren't real happy here.

3:05

So what did we do?

3:06

We went back and we engaged

3:08

our technologist, Okay.

3:09

Not reprimanding, but engaging them.

3:12

And what were they doing when the

3:14

patient was actually on the table?

3:17

Were they doing their reconstructions

3:19

while the patient was on the table?

3:22

They should do that afterwards.

3:23

How can we make this a

3:24

more efficient fast study?

3:27

And there were lots of variability.

3:29

The tech times varied, the non scan

3:31

related activity varied, the table time.

3:34

Varied greatly between technologists.

3:37

And so having this kind of operational

3:40

feedback was very, very important.

3:43

And we share this as a team in a positive way,

3:45

how to make this more efficient and maintain

3:47

our accuracy, optimize our schedule, et cetera.

3:50

T2 again is the longest sequence.

3:54

Is it really necessary?

3:56

It takes about 4 minutes.