“TRU-SCAN MRI” IN CLINICAL PRACTICE –
A RADIOLOGIST’S PERSPECTIVE

By Manuel S. Rose, M.D.
Founder, Rose Radiology Centers, Inc.

“Tru-Scan MRI” is Rose Radiology’s new multi-positional Stand-Up Open MRI manufactured by the Fonar Corporation. The name “Tru-Scan MRI” was adopted because I believed it is a true representation of the images obtained on the Stand-Up MRI. The images are a more accurate and true reflection of the patient body in real life postures.

The new technology premiered in Maryland in 2001. The second installation was brought to Pinellas County by Rose Radiology in January of 2002 and is located in the Boot Ranch section of Palm Harbor, Florida.

Prior to bringing this new and highly specialized MRI product to our area, I researched the concepts of weight bearing (standing or sitting) and flexion/extension MRI. Unfortunately there had been very little written on the subject. However, common sense and intuition about this new technology led me to take the huge financial risk and purchase Tru-Scan MRI.

My findings in our first six months of operation were so substantial that I believed the Tampa Bay area could support another specialized MRI center. I opened Rose Radiology-Brandon as a regional MRI Center to serve Hillsborough County and its surrounding areas in February of 2003. The opening of that site resulted in the 15th installation of this type of MRI worldwide.

At Rose Radiology – Boot Ranch, the Tru-Scan MRI is complimented by the addition of the 1.5T Intera, the best MRI product manufactured by Philips Medical Systems. The Intera is an ultra-fast Cardiovascular MRI, capable of imaging the cardiac chambers and coronary artery. I have compared many hundreds of MRI’s on patients who have been scanned in different positions and using different magnet technology. I base this non-scientific writing on my experience with these two types of MRI machines. However, I am optimistic my beliefs will be confirmed by scientific double blind studies at a later date. I am writing this article because I simply wish to share my experiences and my perspective on this technology.

In the last year and a half, I have reviewed over 5000 MRI’s in various positions of natural weight bearing and have accumulated more experience in this technology than any other radiologist. Since this equipment is not yet available at an academic or research institution, I believe I have some responsibility to share what I have learned with my professional colleagues.

Case Study #1: Position Related Recurrent Disc Herniation
The recumbent scan for this patient with right-sided Radiculopathy following partial Discectomy is shown on the left. The upright scan (right) shows a disc Herniation at L5/S1.

	Recumbent	Seated
Case #1

Case Study #2: Position Related Spinal Instability
The recumbent scan for this patient with recurrent low back pain and polyradiculopathy following L4-S1 laminectomy and fusion is shown on the left. The upright scan (right) shows postoperative intersegmental hyper mobile instability associated with fluctuating stenosis of the central spinal canal at the level above the fusion.

	Recumbent	Seated
Case #2

The concept of imaging in the natural weight bearing position is not new; many of us have preferred standing X-rays long before the first MRI was ever taken, especially our orthopedic colleagues whose preferences have been standing X-rays of the spine and knees. Since MRI allows us to view so much more anatomy than X-ray, it just makes sense to view the body in its natural posture.

After more than a year and a half of working with this specialized MRI, I can say without hesitation that numerous abnormalities not only can, but are missed on conventional MRI imaging of the spine. When it comes to imaging other body parts, TruScan MRI is similar to other open MRI’s in that results do not differ much from varying positions. However, TruScan MRI has the added value of being the most non-claustrophobic MRI available, allowing patients to sit down and watch TV while having their body scanned.

From my experience, about 65% of the differences I see with TruScan MRI occurs in the lumbar spine vs. the cervical or thoracic regions. This percentage coincides with the fact that the lumbar spine typically carries 60% of a patient’s body weight. Of all the cases I have seen of the lumbar spine where the patient has been scanned in the seated or standing position as well as the supine position, I see some difference in lumbar MRI imaging on our TruScan MRI approximately 40% of the time. Basically, 60% of the cases show no variance from the sitting or standing to the supine position, but as many as 40% of all lumbar spine MRI’s may contain additional findings or pathology when scanned in another position (sitting, standing, flexion or extension). Examples of cases scanned with TruScan documenting positive findings from my radiology practice are shown below.

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