Pet/MRI Workflow : An Effort in Collaboration

Background: PET/MR couples two advanced, complex, historically independent, diagnostic imaging modalities allowing detailed soft tissue anatomy and molecular imaging to be acquired simultaneously. This modality holds much promise to the future of Radiology and the care of our patients. Due to the novelty of this modality, the development of a safe, effective, and efficient practice is a challenge for many institutions. The development of the PET/MR practice represented an Enterprise-wide strategic initiative for Mayo Clinic. The Mayo Clinic in Rochester, Minnesota was the first institution in the nation to have the GE Signa PET/MR installed for clinical use. The purpose of this study is to highlight lessons learned from planning to implementation of our clinical practice. Teaching Point Mayo Clinic elected to staff the PET/MR suite with a PET technologist and an MRI technologist to ensure image quality and patient safety. Therefore, technologists from Nuclear Medicine and MRI were required to collaborate and work together in one modality. Hybrid modality education was required for PET/MR staff. The first phase of technologist education at Mayo Clinic focused on safety. MRI safety for PET technologists and radiation protection education for MRI technologists ensured safety of patients and technologists. Educational delivery methods have evolved since the initial group of technologists; however, didactic content and hands -on experiences remain anchors of this most important phase. The second phase of technologist education focused on technical and workflow knowledge of the hybrid modality. Physics education and observation in each technologist’s foreign modality established awareness to allow for collaborative and informative discussions on workflow. PET and MRI data is acquired simultaneously on the GE Signa PET/MR; therefore protocol development began using MRI protocols and integrating MRI sequences into PET bed positions. Mayo Clinic desired to limit PET/MR acquisition times to 60 minutes for patient comfort, satisfaction and scanner throughput. With the limited acquisition time and the limitations of MRI sequences due to locked PET bed positions, strategic changes needed to be made to the protocols to ensure adequate data was collected within 60 minutes. With these changes, the interpretation practice was required to adapt to variances of PET/MR studies in comparison to independent MRI and PET studies. After development, the protocols were tested on volunteers to ensure appropriate scan times as well as assess image quality. Protocol development was finalized by scanning patients consented to have a development PET/MR scan immediately following a clinical PET/CT utilizing the same [¹⁸F] FDG injection, which allowed for PET imaging quality assurance. Broadening the inclusion scope of the initial IRB allowed for a more robust collection of study patients. Operational workflow in PET/MR requires effective communication and collaboration between PET and MRI technologists. Individual aspects of PET and MRI were measured and prioritized within each step of the workflow development to ensure an efficient experience for our patients. Technologist’s specific duties and staffing hours within the two modalities were adjusted and intertwined to provide a safe environment at all times. In the electronic environment, orders were created for a PET/MR exam to utilize verbiage that coincided with the radiologists’ orders, the scanner protocols, and the technologists’ online protocol reference to ensure the correct exam was performed. Summary Designing effective technologist training and fostering a collaborative environment for PET and MRI technologists is essential for development and implementation of PETMR protocols and a sustainable workflow. An effective PET/MR workflow is necessary to enhance the patient’s experience and to provide an opportunity for advanced/hybrid diagnostic imaging.