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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Review ArticlePRACTICE PERSPECTIVES
Open Access

Implementation of a Low-Field Portable MRI Scanner in a Resource-Constrained Environment: Our Experience in Malawi

K. Chetcuti, C. Chilingulo, M.S. Goyal, L. Vidal, N.F. O’Brien, D.G. Postels, K.B. Seydel and T.E. Taylor
American Journal of Neuroradiology April 2022, DOI: https://doi.org/10.3174/ajnr.A7494
K. Chetcuti
aFrom the Department of Paediatrics and Child Health (K.C.)
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C. Chilingulo
bBlantyre Malaria Project (C.C., N.F.O., D.G.P., K.B.S., T.E.T.), Kamuzu University of Health Sciences, Blantyre, Malawi
cDepartment of Radiology (C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
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M.S. Goyal
dMallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri
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L. Vidal
eDivision of Neuroradiology (L.V.), Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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N.F. O’Brien
bBlantyre Malaria Project (C.C., N.F.O., D.G.P., K.B.S., T.E.T.), Kamuzu University of Health Sciences, Blantyre, Malawi
fDivision of Critical Care Medicine (N.F.O.), Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
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D.G. Postels
bBlantyre Malaria Project (C.C., N.F.O., D.G.P., K.B.S., T.E.T.), Kamuzu University of Health Sciences, Blantyre, Malawi
gDepartment of Neurology (D.G.P.), George Washington University/Children’s National Medical Center, Washington, DC
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K.B. Seydel
bBlantyre Malaria Project (C.C., N.F.O., D.G.P., K.B.S., T.E.T.), Kamuzu University of Health Sciences, Blantyre, Malawi
hDepartment of Osteopathic Medical Specialties (K.B.S., T.E.T.), College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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T.E. Taylor
bBlantyre Malaria Project (C.C., N.F.O., D.G.P., K.B.S., T.E.T.), Kamuzu University of Health Sciences, Blantyre, Malawi
hDepartment of Osteopathic Medical Specialties (K.B.S., T.E.T.), College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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  • FIG 1.
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    FIG 1.

    Hyperfine Swoop MR images of a 12-year-old child who was admitted to the pediatric ward at our institution with focal neurology, reduced consciousness, and septicemia when CT imaging was not available at our institution. The child’s MR imaging demonstrated a right-sided subdural empyema, which was confirmed at surgery. MR imaging findings were of a well-defined, septated T2-weighted hyperintense subdural fluid collection associated with mass effect (A), with a corresponding T1-weighted hyperintense subdural fluid collection (B).

  • FIG 2.
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    FIG 2.

    Hyperfine Swoop MR images of a 6-year-old child who was admitted to our institution under the research study arm with a decreased level of consciousness and malaria parasitemia. The child’s MR imaging demonstrates typical findings associated with malarial encephalopathy of diffuse right-sided parietotemporal T2-weighted hyperintensity in the gray and subcortical white matter with an associated localized mass effect in the form of sulcal effacement on the coronal T2-weighted sequence (A), with corresponding restriction of diffusion on the DWI b=900 image and ADC images (B and C).

  • FIG 3.
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    FIG 3.

    The Hyperfine Swoop, still crated, at the time of receipt at our institution.

  • FIG 4.
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    FIG 4.

    The Hyperfine Swoop at our institution is set up in an appropriately optimized temperature- and humidity-controlled dedicated scanning room (A) with a patient scanning couch of an appropriate height adjacent to it. B and C, The blue padding block was sourced by our group and is applied within the head coil of the scanner with the gray manufacturer-provided padding applied over it, extending onto the patient’s scanning couch. The role of the blue padding block is to elevate the patient’s head a little further, thereby optimizing the patient’s head position further in the scanner head coil for more optimal head coverage during scanning. A patient model within the scanner (D) demonstrating the swaddling technique and a detailed view of the patient’s head position within the head coil (E).

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  • Challenges encountered and proposed solutions for low-field MR imaging implementation in a resource-limited setting

    ChallengeProposed Solution/Troubleshooting Option
    Equipment delivery and receipt logisticsNeeds assessment of the most reliable and safe equipment transportation routeUse of a reputable carrier with tracking facilitiesInsurance coverageUncrating and setup training before equipment receiptAcquisition of tools needed for uncrating and setup before equipment receiptOn receipt, close inspection of external container gauges for warnings
    Equipment roadmapNeeds assessment of the expected routes of equipment portability within the health care facilityConstruction of low-incline, smooth ramps to mitigate steep and irregular terrain
    Equipment storageNeeds assessment of storage and operating conditions inclusive of temperature and humidity
    Equipment operationTraining of end user operators
    Equipment utilitiesNeeds assessment of hospital infrastructure including electricity supply and Internet speedAcquisition of a manufacturer-recommended compatible electrical surge protector
    Non-resource-constrained specific itemsPatient and equipment safetyPatient privacy and confidentiality
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K. Chetcuti, C. Chilingulo, M.S. Goyal, L. Vidal, N.F. O’Brien, D.G. Postels, K.B. Seydel, T.E. Taylor
Implementation of a Low-Field Portable MRI Scanner in a Resource-Constrained Environment: Our Experience in Malawi
American Journal of Neuroradiology Apr 2022, DOI: 10.3174/ajnr.A7494

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Implementation of a Low-Field Portable MRI Scanner in a Resource-Constrained Environment: Our Experience in Malawi
K. Chetcuti, C. Chilingulo, M.S. Goyal, L. Vidal, N.F. O’Brien, D.G. Postels, K.B. Seydel, T.E. Taylor
American Journal of Neuroradiology Apr 2022, DOI: 10.3174/ajnr.A7494
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