Is Newer Technology Better Technology? - CADTH · Is Newer Technology Better Technology? CADTH Compares 1.5 Tesla and 3.0 Tesla MRI Scanners Rhonda Boudreau CADTH Symposium April

Is Newer Technology Better

Technology? CADTH Compares 1.5 Tesla and 3.0 Tesla MRI Scanners

Rhonda Boudreau

CADTH Symposium April 16, 2012

Newer Technology Better Technology?

Societal desire for newer, “cutting-edge” technologies.

• iPad 3

• iPhone 4

• Windows 8

• Ford Escape 2009, 2010, 2011…

• Razors



Gillette Fusion ProGlide Power Razor

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BIC Comfort 3 Advance

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• Technology is neither inherently good or evil

• General belief or assumption that new medical

technologies equals better patient care

But,

is newer technology always better for Canadians?

The Policy Issue

1.5 Tesla MRI versus 3.0 Tesla MRI

Policy Issues (“Knowledge Gaps”)

• Are there health care settings and clinical

indications where a 3.0 Tesla MRI scanner provides

a clinically significant diagnostic or therapeutic

advantage, or disadvantage, over a 1.5 Tesla MRI

scanner?

• Can a 3.0 Tesla MRI scanner function as a stand-

alone unit or is a 1.5 Tesla MRI scanner also

required as back-up?

A Complicated Decision

Purchasing decisions related to MRI scanners are

complicated:

• High-cost

• Rapidly incrementally advancing technology (faster than

evidence generation)

• Wide range of current clinical applications

• Future clinical applications

• Purchased MRI may have to be used for a number of years

• Safety (e.g., increased noise, heat)

From Request to Guidance: Key Steps

• Refinement of research questions with customer

• Production of systematic review and other

information materials

• Assembled the MRI Expert Review Panel to produce

guidance

Systematic Review

636 citations identified

in literature search

46 potentially

relevant studies

3 potentially relevant

studies from

other sources

25 relevant studies:

6 neurology

4 cerebrovascular

1 renal

3 coronary artery disease

3 musculoskeletal

8 oncology

21 excluded studies

after full-text review

Reasons for exclusion:

• small sample size

• study design issue

• time between MRI

scans too far apart

43 potentially relevant primary studies

identified from literature search

CADTH. 1.5 Tesla magnetic resonance imaging scanners compared with 3.0 tesla magnetic resonance

imaging scanners; 2011

Systematic Review

• Included studies were comparative, prospective,

often blinded

• No included studies assessed clinical management

or change in patient outcome

• Clinical test parameters such as identifying lesions,

nerve visibility

• Most commonly reported that 3.0 Tesla was similar

or better than 1.5 Tesla MRI

• A few cases where 1.5 Tesla was better



Chair

Dr. Jean Gray (NS)

Clinical Expert Members

Dr. Darren Ferguson (NB)

Dr. Martin Charron (ON)

Dr. Alexander Dick (ON)

Dr. Matthias Schmidt (NS)

Dr. Andre le Roux (NB)

CADTH Committee Members Dr. Scott Klarenbach (AB)

Dr. James Silvius (AB)

Dr. Lindsay Nicolle (MB)

Public Member

Mr. Harlon Davey (ON)

MRI Expert Advisory Panel

Information Used for Guidance

In developing the guidance, the CADTH MRI Expert

Advisory Panel considered the following:

• Systematic review

• Supplemental narrative review on safety issues

• Manufacturer information

• Clinical and technical expertise

• Public values and preferences

• Stakeholder feedback

Summary of Guidance

First Issue (Knowledge Gap)

Are there health care settings and clinical

indications where a 3.0 Tesla MRI scanner

provides a clinically significant diagnostic or

therapeutic advantage, or disadvantage, over a

1.5 Tesla MRI scanner?

For most medical conditions, use of 3.0 Tesla

MRI or 1.5 Tesla MRI leads to similar clinical

outcomes, including safety.



Summary of Guidance

3.0 Tesla MRI may offer advantages for:

• advanced neuroscience assessment and

therapeutics (neurovascular diseases,

neuro-oncology, epilepsy)

• some cardiovascular applications (e.g., myocardial

perfusion, peripheral vascular angiography).

Summary of Guidance

Second Issue (Knowledge Gap)

Can a 3.0 Tesla MRI function as a stand-alone unit or is

a 1.5 Tesla MRI also required as back-up?

• Yes, though current practice suggests it be

partnered with 1.5 Tesla MRI to better serve the full

spectrum of patients.

• Decisions regarding placement of a 3.0 Tesla MRI

or 1.5 T MRI should be made with considerations to

clinical services being delivered.



Where to apply 3.0 Tesla MRI?

• Where its enhanced diagnostic

capacity will support clinical

programs

• Keeping in mind that 3.0 Tesla

MRI requires greater support

for its operation (more clinical

expertise & paramedical

personnel)

• Where synergies with research

capacity can be realized

Summary of Guidance

Impact

A change or a decision that is a result of,

or influenced by, products and services

delivered by CADTH to its customers.

Impact

Evidence-informed decision making

• Regularly cited as primary source of evidence used

to help inform the MRI purchasing decision.

Impact

Helping debunk the myth that newer

technology is the better technology

• If better is defined in terms of improved patient

health outcomes – newer is not always better.

• In the case of 1.5 Tesla MRI and 3.0 Tesla MRI, newer

technology may not always mean better patient care.

Impact

Provide continuing support

• Knowledge exchange tools to raise awareness

• Knowledge exchange tools tailored to specific needs

Acknowledgements

• Expert Review Panel

• ProMed (Ron Wood)

• CADTH Staff

CADTH web site: www.cadth.ca

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Is Newer Technology Better Technology? - CADTH · Is Newer Technology Better Technology? CADTH Compares 1.5 Tesla and 3.0 Tesla MRI Scanners Rhonda Boudreau CADTH Symposium April