Training MRI technologists in China

by David M. Cash,
Director of Medical Imaging

"Nihao from Beijing! I've been over in China the past week visiting hospitals and training MRI technologists on how to perform scanning for Alzheimer's Disease clinical trials. When I first heard that I would be going to China, I must admit to some trepidation. First of all, I've never traveled to Asia before. As a result, the irrational side of me was over-preparing for culture shock and home sickness. I was worried about getting lost, not speaking the language, and committing some cultural gaffe that would transmute into an international incident. One thing that helped alleve my concerns was that I would have my colleague Dr. Mingxing Hu, accompanying me on this journey. Mingxing has become a medical imaging expert, working on research in both English and Chinese centres. He also is a native Mandarin speaker and lived in Beijing for 6 years, so he knew the city pretty well.

When I first arrived Beijing I was blown away by the sheer size of the city, with skyscrapers soaring upwards for miles and miles. The immensity of the city and it's rapid growth could also be an appropriate metaphor for the problem of Alzheimer's Disease in China. According to the landmark research by the 10/66 group, China has the most AD cases of any nation, an estimated 5.0 million out of 24.3 million cases worldwide. By 2040, their estimates have this number rising over 300% to 26.1 million (of 81 million worldwide), primarily due to the nation's ageing population. Some estimate, China will be have half of all cases by 2050. At the same time, as the family size is shrinking in China, there will be fewer family members to serve as caregivers when their loved ones become ill.

Another thing that becomes very obvious is the crackling and fast pace of the city, primarily by watching the traffic as you nervously stick your toe out in an attempt to cross the street. Our first training session with the MRI technologists reflected this energy, as technologists beyond Beijing, from Xi'an to Shanghai to Guanzhou quickly absorbed the information through translators and returned with thoughtful questions about our methods. Many of them seemed very excited to be working on this trial. At the same time, we felt their concern as well, because they wanted to prove that Chinese sites could also participate in an increasingly global effort to find suitable biomarkers of prediction and disease modification for this disease, spearheaded by the Worldwide Alzheimer's Disease Neuroimaging Initiative (WW-ADNI).

While here, we also had the opportunity to visit a few hospitals around Beijing. Again, in planning for this trip, I had some challenges that I needed answers to. Would the sites have modern equipment and workflows in terms of acquiring, moving, and archiving data. Would any data protection laws or regulations make it difficult to get the data to us? DICOM supports Chinese characters, but how far did that support go? Did the main scanners support this feature? Would our systems be able to read the data?

Most of these issues disappeared within a few minutes of each visit. As with every other Chinese host I have had during this trip, the site staff was most hospitable, opening up their facilities to us and answering any questions we had. All the sites had pretty modern equipment (with a fair amount of 3T scanners), including their PACS. Mingxing was there to help assure the site staff and discuss more about the technical details. However, there was also a universal language or MRI and DICOM, which made it easier to discuss sequences, parameters, and file formats.

There will still be a few challenges. My jokes during the training didn't work through translation, but then they don't normally work in English either. Some sites may find it difficult to find 30 minute blocks to scan patients with a full safety and volumetic imaging protocol, as they currently work incredibly hard, operating the scanner 12 hours a day and usually can provide only 10-15 minutes for slots. The external network infrastructure of the imaging sites is less developed than in some other parts of the world. Overall, these challenges seem trivial amidst all of the potential here of acquiring data that could be critical for future AD trials."

David M. Cash, Ph. D.
Director of Medical Imaging