Years ago, as a medical student at UCLA, I had the opportunity to perform research on magnetic resonance imaging (MRI). We studied the feasibility of visualizing the cornea of the eye. As technology advances, MRIs become more powerful but remain relatively safe. They utilize magnetic energy to measure water density of certain structures in the body. By contrast, CAT scans (CT) use radiation to measure mineral density, which, when overutilized, can increase cancer risk.

The most important factor in determining the potential image resolution of MRI is the Tesla (T) rating. The latest machines use a 3.0T rating. In Hawaii, state-of-the-art 3.0Ts are housed at InVision Imaging, Hawaii Advanced Imaging, Queen’s, Tripler and Kaiser. Yeoh and Muranaka Radiology, a free-standing radiology company, recently purchased a new 3.0T MRI which has not, as yet, been put to work.

According to Dr. Edwin Muranaka, the 3.0T is so powerful, it is as good as a CT to identify a fracture. Less powerful MRIs, which are more commonly in use, are able to demonstrate bone edema, or increased fluid, but cannot readily reveal an actual fracture. The 3.0T also offers significantly better sensitivity and grading of cartilage lesions at the knee and many other body parts.

Obviously, the 3.0T machines cost more to acquire, install and maintain. Whereas a 1.5T machine runs approximately $1.5 million, a 3.0T is closer to $2.5 million. The better machines also weigh more, which requires more construction, better shielding, insulation and more.

The problem is that reimbursement for MRI studies is the same regardless of the age of the machine or its power.

At the same time, physicians, particularly surgeons who depend on MRI studies for important medical decisions, demand top-quality images. This puts a tremendous squeeze on hospitals and free-standing radiology companies to make ends meet while they provide cutting-edge images. The best way to cover the huge capital investment and fixed costs is to perform more studies.

This kind of fiscal pressure has the potential to result in unnecessary MRI studies, which drive up the cost of health care. There also is increasing awareness of MRI studies among health care consumers. At least once a week, a patient will say, "Can I just get an MRI to see what’s going on?"

For a busy provider, it is sometimes easier to order the study than educate the patient. MRIs are expensive and are indicated in only certain cases.

Last week this column covered the demise of Holistica Hawaii at Hilton Hawaiian Village and the success of Yeoh and Muranaka to illustrate the fact that technology alone is not a recipe for success in health care. Core values, patient-centered care and sustainable relationships are essential to maintain and increase market share in this highly competitive area of medicine.

InVision Imaging, another free-standing facility that offers top-quality 3.0T MRI images and excellent customer service, has been booming. According to president Eric Hannum, "I wanted to integrate a high-tech and high-touch approach. High tech was obviously delivering quality with the Philips 3.0T. High touch was really providing patients with a spa-like experience. Even with reduced reimbursement staring us in the face, we knew at the end of the day, we were going to have the best offering in the marketplace."

Giving back is an added benefit of success. Hannum has worked hard to make this locally owned imaging center an integral part of the community. InVision has donated to more than 10 different charities.

"That’s something very important to us and something we take great pride in."

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.