Author: Ndey Badjan, Chris Beasley, Issack Boru, Josh Joyner, Erica Owenby, Scott H. Robertson, Nicholas Said 👨🔬
Affiliation: Duke University Health System 🌍
Purpose:
To design MRI-visible laterality markers to boost patient safety by minimizing errors in laterality and subsequent procedures.
Methods:
The markers were made using commercially available silicone doped with MultiHance (0.2% by volume) to enhance marker conspicuity. Doped silicone was poured into a 3D printed PLA molds which were designed to be durable and easily cleanable for infection control. The silicone was degassed for 5 minutes in a vacuum chamber to remove bubbles. Markers were printed with "R" and "L" letters to indicate laterality and were color-coded for easy identification. Two sizes were produced: small 4x4x0.5cm markers that fit inside the various RF coils for musculoskeletal imaging and large (6.5x6.5x2.5cm) to remain resolvable resolutions used in body imaging.
To encourage adoption, technologist usage in MSK MRI was monitored for 7 months by auditing 20 random exams each month.
Results:
Silicone laterality markers were readily visible in both spin echo and gradient echo images, appearing slightly hypointense compared to tissues. Fat suppression reduced marker intensity. The large size and distinct shapes of the makers made them easily seen in localizer images without special positioning. The estimated material costs for a left/right pair of markers to is $0.75 for small and $6.50 for large markers. We anticipate manufacturing costs could be lower with mass-produced injection molding. An initial marker audit found that markers were only used in 40% of MSK exams. During a four-month period, marker adoption grew to over 90%, which was sustained for four consecutive months.
Conclusion:
MRI-visible silicone laterality markers provide a reliable, reusable, and cost-effective approach to denoting laterality directly in MR imaging. This method reduces the potential risk for mislabeled images.