MRI and CT have totally revolutionised the practice of medicine over the past 30 years. Conventional MR and CT systems are designed so that that the patient is scanned in the horizontal position (typically supine), and in the case of MRI, is either examined in a tunnel, with a high-field magnet, or between two large magnetised plates in a low-field, so called ‘open’ system.

Traditionally, high-field (e.g. 1.5T) ‘tunnel’ systems are judged to give the best quality images. However, a significant proportion of patients are too claustrophobic to tolerate the confines of the tunnel. Also, very limited access to the patient whilst in the tunnel causes difficulties with scanning children, obese and confused patients, or those unable to lie supine and still for the required time. Traditional ‘open’ scanners are less claustrophobic but are lower in field strength (typically 0.2 – 0.5T, although higher field strength scanners are now becoming available), with some compromise in image quality, although the constant improvement in both coil technology and software over the past few years has significantly narrowed the gap in image quality between low and higher-field systems. Both conventional tunnel and open systems only scan in the supine, non-weight-bearing position.

The London Upright MRI Centre (LUMRIC) has recently installed The Fonar Upright MRI scanner into a dedicated centre in central London. This approach to MRI is unique, being the only MR system currently available that is able to scan patients in the upright, weight-bearing position. The only other machine capable of doing this in the UK is installed at the University of Aberdeen.

The revolutionary design of the scanner enables patients to simply walk in and be scanned. The Upright MRI allows all parts of the body, particularly the spine and joints, to be imaged in the weight-bearing state. The scanner is equipped with a unique patient handling system that moves the patient into the magnet and places the anatomy of interest into the centre of the magnetic field. It also can rotate the vertically-orientated patient into a horizontal position (or anywhere in between) so the patient can be scanned lying down as in conventional MRI scanning. Because the patient is typically upright (either standing or sitting in a special chair) or at say, a 30 degree angle, and has an unrestricted view in front of them, problems with claustrophobia are effectively eliminated. What has also been found is that patients who were not even able to tolerate conventional ‘open’ MR scanners have been scanned successfully and have reported no discomfort in the upright system.

It should come as no surprise that the MR appearances of the spine are not necessarily the same in the upright as in the supine position, because of the weight-bearing state of the former. But of course, the key question is: does this method of scanning influence patient management?

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