Developing International Protocols and Standardized Scanners

David Li, MD, FRCPC: I think one of the things that came about from the meeting besides trying to make it more widely used was trying to home in on the protocols themselves. One of the aims that we would like to be able to do is to have the MAGNIMS [Magnetic Resonance Imaging in Multiple Sclerosis], and the CMSC [Consortium of Multiple Sclerosis Centers]—and we had representatives from the North American Imaging in Multiple Sclerosis group—have an international set of commonly agreed to MRI [magnetic resonance imaging] protocols, which are very similar in terms of what sequences are to be used, the slide thickness, and the details of it. It was nice to have the vendors there because we’re looking to see whether we can get their help in terms of having these available on their scanners, so that they can become easily available.

We had a lot of discussion about standardization for optimization. Very often people think about standardized scans as being inferior scans. But it’s, in fact, the opposite because you can optimize a standardized examination, and you can do it well. By having that optimized standardized examination, you’re actually providing optimal care rather than substandard care. So I think it’s very important to make that distinction. I think there will be a lot of work in terms of trying to make that possible.

June Halper, MSN, APC-C, MSCN, FAAN: Yes, you warned me about the work.

David Li, MD, FRCPC: Yes.

Scott D. Newsome, DO, MSCS, FAAN: But I think it’s important to have the international presence and have people from different groups come together and agree upon what the bare minimum core sequences are or how we follow people over time, even though it’s going to be a little bit dynamic based on where you are in the world. I think that’s going to help push things forward. That’s the McDonald Criteria, right? When those are changed over time, it’s an international presence of experts.

June Halper, MSN, APC-C, MSCN, FAAN: Right.

Frederik Barkhof, MD, PhD: Definitely.

Anthony Traboulsee, MD, FRCPC: We come from different healthcare styles—Europe, Canada, and the United States—yet we all have very similar fundamental goals of getting good quality imaging and using resources in a reasonable way, in an effective way. It’s really interesting at these meetings how we come together to roughly the same place in terms of what we think we need and how we can achieve that.

David Li, MD, FRCPC: I think one of the things we talked about earlier as well is that within our guidelines right now, we have specific things to do with the MR [magnetic resonance] and the specific things about how the MR should be used in a clinical setting. One of the things that we can work on in terms of making it common and similar is the details of that MRI protocol. The clinical indication and how the MR is to be used will vary region to region, country to country, and district to district because there will be local differences in practice and how drugs may or may not be available or how frequently they’re available. But the core way of scanning the patient could be, in fact, very common and similar between all regions. That would really help solve a lot of issues about people moving or having new scanners and all the difficulties that we have from that.

June Halper, MSN, APC-C, MSCN, FAAN: We could have panels like this where you could target specific healthcare professionals, such as the technician or the radiologist, and I think it would be extremely important as an international effort. Maybe it would have to be in different languages. We were talking earlier about some language barriers.