5 Reasons Why You Do Not Want a Mobile MRI –On The African Continent
Estimated reading time: 5 min
To some, a mobile MRI unit sounds like the perfect solution. Especially when you want to bring diagnostic imaging to patients in rural areas. As such you might think a mobile MRI or CT would be the perfect solution for a continent as big and diversified as the African continent. No rules without exception, but generally I do not agree with that at all.
You might not agree with me first of, but after you read this, maybe you will.
Let’s be clear, when looking at an entire continent it’s impossible to be accurate. There is too big a difference between the countries. For instance, the needs of Egypt, Nigeria, South Africa and Sudan are not the same.
Looking from a helicopter perspective there can be no arguing that the need for medical imaging equipment like MRI is great in the African continent. If you take a look at the image below from WHO, 2014 it is clear that Africa is the continent with fewest MRI units per million population.
At first, it might seem like a great idea to invest in a fleet of mobile MRIs for the African countries. But, when you take everything into account, it might not be such a great idea after all. The need is clinical there, but there are massive obstacles.
I have accumulated the key points in a few chapters. You can access each here to make it easy to jump straight to the points that interest you the most at first.
When the Best Option is in Fact Not an Option
For most parts of Africa, I always recommend choosing a permanent magnet. Read more about this in another blog post later this year.
But, as a permanent magnet weighs in the range of 16.000kg and also has a bigger footprint than a high-field. It simply does not fit into a mobile solution. The trailer itself would also get heavier due to extra reinforcements and an extra set of wheels. In total, the weight would get to about 30.000kg. That kind of weight is not only heavy, it is too heavy.
So, if you insist on a mobile solution, the only real option is a high-field MRI. Below I will look at some of the key issues arising from operating a high-field mobile MRI.
Difficulties on the Road
A mobile MRI unit travels many miles and not all the roads are paved with smooth asphalt like in the cities. The many miles driven on bumpy roads will lead to failing boards and significantly more service than fixed-site MRI’s. That alone means higher expenses than for an MRI unit at a clinic or a hospital.
Also, moving the mobile MRI on bumpy roads can easily lead to magnet quenches. As I am sure that you are aware of, this is not something to take lightly. Keeping an MRI filled with liquid helium is also a very expensive affair and also not widely available across the continent.
When moving an MRI from place to place you are very much dependent on the sites to be ready for you. For instance, this means that enough power infrastructure has been established at all locations.
Typically you will need 125 AMP. To establish this is not cheap or without difficulties. Even in Europe, you can not get this everywhere. Also, it goes without saying that the power grid needs to be stable and without power cuts. Unstable power or power cuts can lead to quenches.
Because of the constant risk of a quench, you must have a local supplier of liquid helium. This is because you need to be able to get 250-500 litres of helium within 24 hours at all times. Otherwise, an elsewise functional system risks getting damaged beyond realistic repair/cooldown.
The price of helium is fluctuating and is different between regions. As of today, in the EU we are paying in the range of USD 22 per litre. But in Africa, we have seen prices anywhere from USD 35 to almost USD 50 per litre.
If you are curious to see a controlled magnet quench this is a video of such a thing.
Keeping Your Patients and System Chilled
The walls of a mobile MRI are thin and scarcely isolated. There is simply no room for much else as a high-field MRI system takes up a lot of space.
This also means the temperature inside the trailer is very much influenced by the temperature outside the trailer. Typically a trailer built in Europe is equipped with air conditioning suitable for the European climate. So, when it hits significantly higher temperatures it cannot keep up. This results in overheating of electronics which again results in the system breaking down.
Used mobile systems are extremely rarely equipped with enough isolation to deal with the African climate. If you buy a brand new one it might be different, but that is at a completely different price point.
The largely unmet need for MRIs and the vast distances on the African continent make mobile MRI units seem like the right match. It is my claim that it is not.
It is too costly an affair to maintain and repair them in the long run. If you proceed and get a mobile MRI anyway, I will almost guarantee that you will end up with a warm, quenched magnet too expensive to bring back to service.
Buying an MRI is not about the initial investment. The key is the total cost of ownership and THE most expensive system to own is a mobile MRI.
The money would be better spent on transporting the patients to the MRI and not the other way around. One could also choose to buy more MRIs.
In my view getting the patients to the equipment and getting them a proper diagnosis is the best solution for most places in Africa.