Accurate imaging diagnostic tests are essential in modern healthcare. These techniques allow for the assessment of different health issues and provide clinicians with the information they need to select appropriate care for their patients. Tests like magnetic resonance imaging (MRI) and computed tomography (CT) can detect cancer and provide further information, such as tumor stage, which is essential in choosing treatment options.
Despite their utility, challenges in imaging diagnostics can lead to inaccurate results and even misdiagnosis. Patient obesity raises several challenges in diagnostic imaging tests, including reduced image quality, equipment limitations, and diminished patient comfort. These challenges can make it difficult for healthcare providers to treat obese patients effectively.
Given the prevalence of obesity (>40 percent of adults in the USA), these issues can limit healthcare options for a significant portion of the population. This article will discuss the challenges faced with imaging obese patients and highlight current and future solutions for diagnostic imaging of this population.
Obesity raises many issues when using conventional imaging equipment. While efforts to improve accessibility are ongoing, many of these issues pose significant challenges for the diagnosis and treatment of diseases in obese patients.
Standard imaging equipment has weight and bore size limitations, which can exclude some obese individuals. For instance, larger CT platforms have a weight limit of 308 kg, but smaller industry-standard machines have a limit of around 205 kg. The industry standard for open and closed magnetic resonance imaging (MRI) has a weight limit of 159 kg, although versions that support 250 kg are available. The bore aperture diameter is often a more significant limiting factor than weight. Today, larger CT scanners have a bore diameter of 85 cm, and MRI scanners have a diameter of up to 70 cm.
Several factors put obese patients at increased risk of harm during diagnostic imaging. For CT scans, a higher radiation dose is typically required for effective imaging of obese patients. In a closed MRI scanner, claustrophobia can become an issue for some obese patients due to a lack of space. The narrowness of imaging tables can also be a source of discomfort for obese patients. Furthermore, there is a chance of burn issues in MRI scanners if the patient comes into direct contact with the inner surface of the bore.
Ultrasounds are not limited by the weight limit or bore size of instruments and are, therefore, more accommodating to patient comfort. However, ultrasound waves are directly blocked by adipose (fat) tissue, which limits the utility of this technique in obese patients. CT scans can obtain higher-quality images; however, the longer time taken for photons to penetrate adipose tissue in obese patients can lead to imaging abnormalities (artifacts).
MRI images are also prone to artifacts when scanning obese patients, though the radiofrequency beam used in MRI is less susceptible to issues than X-ray beams used in CT scans. Increasing the field strength of MRI scanners can help mitigate these issues, though this can significantly increase the signal-to-noise ratio. “Noisy” images are a significant barrier to accurate diagnosis.
While options for obese individuals are limited in some cases, it’s essential to understand the best options available to direct effective care.
CT scans can provide significant advantages for imaging obese patients compared to other methods. For instance, CT scans can offer higher resolution than methods like ultrasound. Modern CT imagers are designed to accommodate higher weights and body sizes, increasing accessibility for obese individuals.
MRI scans are particularly effective at soft tissue contrast, which makes them valuable in imagining obese patients who are more likely to have internal fat deposits surrounding internal organs. Furthermore, MRIs do not expose obese patients to radiation, which can be a significant issue with CT scans, where prolonged exposure may be required for obese patients.
Ultrasounds are particularly useful when a patient's size prevents the use of CT or MRI scanners. Furthermore, ultrasound equipment is more portable, which means it can be used at the patient's bedside. Ultrasounds are particularly useful for imaging the heart and helping with diagnosing cardiovascular issues, which are more prevalent in obese individuals.
Fortunately, new techniques and technologies are constantly emerging that are helping to improve the use of diagnostic imaging tests for obese individuals.
Dual-energy CT (DECT) is a type of medical imaging that uses two different energy levels of X-rays to produce detailed images of the body. A recent study found clinicians preferred images of internal organs like the spleen, pancreas, kidneys, and liver generated using DECT compared to conventional CT. Artificial intelligence (AI) is effective in improving the quality of CT scans of obese individuals, leading to improved diagnostic confidence.
Modern imaging equipment is being adapted to support higher patient sizes and weights. This includes using reinforced tables and wider bores in MRI scanners. However, more innovations are required to ensure obese individuals have the same access to high-quality healthcare as non-obese individuals.
Maintaining accurate patient weight and size data is essential for determining their suitability for different scanning methods. Automated systems can alert clinicians if their patient exceeds the weight limits of imaging equipment. Furthermore, healthcare providers should be aware of the stigmatization that obese individuals face, especially within healthcare fields. Healthcare providers should always take patient comfort and dignity into account. For example, there may be instances where an obese patient may be eligible for scanning using an MRI machine, but they may not feel comfortable using one due to fears related to claustrophobia. Clinicians may be able to offer open MRI as an alternative in such a case.
Healthcare providers should also ensure they have the relevant training for managing obese patients, particularly when establishing parameters for scanning procedures. This includes determining if the platform will affect patient comfort and how the imaging protocol may need to be adjusted. Communication with the patient is essential at all stages to provide the best healthcare and ensure optimal outcomes.
Poorer quality diagnosis from imaging tests is one area where obesity may have a significant negative impact on individual outcomes. Understanding this impact is important for directing efforts toward improved patient care.
Early and accurate diagnosis is essential for improving treatment outcomes, and obese individuals are at a higher risk of developing certain diseases like cancer. This fact highlights the urgent need to address limitations in imagining techniques for obese individuals.
Patient comfort and dignity can play an essential role in healthcare outcomes. Effective and nonjudgmental communication between healthcare professionals and patients can increase patient cooperation and lead to improved outcomes.
High-quality imaging leads to more accurate and faster diagnosis, which has significant long-term health benefits. With early and precise diagnosis, diseases like cancer can be managed more effectively, and the healthcare provider can select the proper health regimen.
Regular checkups are important for ongoing health, especially for individuals more susceptible to certain diseases. Furthermore, continuous monitoring is crucial for monitoring disease progression and determining the impact of treatment.
The field of imaging diagnostics faces significant challenges in effectively assessing obese patients. These challenges, including technical limitations, patient comfort, and diagnostic accuracy, hinder optimal healthcare for a large sector of the population. Advancements in imaging technology and equipment modifications are helping to provide better solutions. Techniques such as DECT and the incorporation of AI are improving image quality and diagnostic confidence. Healthcare providers must maintain accurate patient data, prioritize patient comfort, and provide non-judgmental care to improve health outcomes. Continued innovation and education in this area are crucial for ensuring equitable healthcare access for all patients. Selecting the appropriate imaging procedure for individual patients is essential for accurate and timely diagnosis.
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