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VISIONS Magazine


August 27, 2021

The Instituto Musculoesquelético Europeo (IMSKE; European Musculoskeletal Institute) is a new specialist hospital in Valencia, Spain. Opened in 2020, the pioneering facility is unique. It offers a wide spectrum of expertise in trauma care, including rheumatology, sport medicine, rehabilitation, physiotherapy within the context of plastic surgery, pediatric orthopedics, chiropody, nutrition, psychology, dermatology and neurology. The IMSKE has a multidisciplinary team of 70 muscu-loskeletal specialists and is fully equipped with Canon Medical imaging equipment. VISIONS explores how the institute is set to become the best traumatology hospital in Spain.

Integrated musculoskeletal care

The IMSKE was created by brother and sister, Dr. Ignacio and Dr. Isabel Muñoz Criado, who recognized the need for better facilities for dedicated musculoskeletal care almost a decade ago. Now Medical Director of the IMSKE, Dr. Ignacio Muñoz Criado is renowned as one of the best orthopedic surgeons and traumatologists in Spain. He has established a solid reputation in private hospital environments and in treating tennis professionals. His sister, Dr. Isabel Muñoz Criado, a graduate of Medicine and Pharmacy from Valencia University, in Spain, was also Manager of the Higher Public Health Research Center (CSISP) and the Príncipe Felipe Research Center, both in Valencia, Spain, before becoming Managing Director of the IMKSE.
“Our aim is to give integrated care with regard to musculoskeletal pathology, so that the patient can continue his or her rehabilitation with good results. Therefore, the patient who visits an orthopedist with an unknown condition can be sent to the right specialist immediately with proper diagnosis, even if that is in another discipline, and we can start resolving the problem on the same day. We want this to also include patient care with regard to prevention,” Dr. Isabel Muñoz Criado explained.

“Our vision is to ensure that patients and their relatives, have an exceptional experience; and this also extends to the professionals such as doctors and nursing staff. We want them to feel comfortable in their workplace. I’m very happy because we are creating a fantastic team. We have contracted people directly at a time that is very complicated, as currently there are a lack of doctors and nurses on a national level. It’s a shared culture and everybody who joins us, makes it his or her own. It’s transferred to everyone who joins the team. This is invariably transferred to patients. They are treated so well that they leave happy.”

Expertly equipped

The IMSKE Team chose Canon Medical to equip the state-of-the-art facility and have installed Canon Medical’s Vantage Galan 3T, Aquilion Lightning, Aceso, Aplio i800, Ziehm C-arm and Vitrea post-processing.

“Canon Medical’s Project Manager, Roberto Sanz, made it all easy as from the first moment. Everything ran very smoothly with the service engineers responsible for the installation and the application experts, who provided the training. I’m very happy with the entire team,” remarked Dr. Isabel Muñoz Criado.
Dr. Isabel Muñoz Criado, Managing Director of the IMKSE.
Dr. Eva Llopis is Head of the Imaging Department at the IMSKE. She is also the Vice President of the SSR (Society of Skeletal Radiology), was the President of the Spanish Musculoskeletal Radiology Society (Sociedad Española de Radiología Musculo-Esquelética, SERME), and is on the Board of the International Skeletal Society (ISS).
Dr. Eva Llopis is Head of the Imaging Department at the IMSKE. She is also the Vice President of the SSR (Society of Skeletal Radiology), was the President of the Spanish Musculoskeletal Radiology Society (Sociedad Española de Radiología Musculo-Esquelética, SERME), and is on the Board of the International Skeletal Society (ISS).

“One benefit of being in contact with various international societies is that you can engage with other colleagues and get to know the issues that they have and how they have resolved them. This has allowed me to become familiar with the experiences of many of them,” she explained. “What I liked best was that I found out that Canon Medical has the capacity to collaborate on a project from the initial phase, right through to the development and implementation of the systems.”

“They told me that Canon Medical are trustworthy. This gives you much peace of mind when you are about to purchase all the medical diagnostics equipment for a hospital. This is the reason why we decided that all equipment should be of the same brand and why we wanted Canon Medical to be the supplier,” she added. “Now I can state that they support you through the entire journey from project start to finish by advising and assisting during all project phases. I can also confirm the overall willingness of Canon Medical not only to assist, but to listen to our proposals and implement them and always with positive feedback.”

Best diagnoses

The IMSKE needed to select machines that could guarantee the best diagnosis in conventional radiology, ultrasound and 3 Tesla MRI. Their criteria included best image quality, fastest speed, reliability and accessibility.

The Aplio i800 ultrasound machine is used to examine small articulations and soft and superficial parts.

“We can say that we have the best ultrasound system on the market, the Aplio i800,” remarked Dr. Llopis. “The hockey stick is incredible when it comes to examining hands and feet. We also find the transducer (probe) for soft parts amazing: it provides excellent resolution.”

“There are more and more percutaneous procedures that are minimally invasive through ultrasound technology and, in this sense, the Aplio i800 is Canon Medical’s ‘big gun’, since it gives us an incredible quality and helps with regard to surgery and diagnostics,” said Dr. Ignacio Muñoz Criado. “I would like there to be an Aplio i800 in every consultation room. Today, this is not possible, but a day will come when every doctor will have one and will diagnose and treat in real time.”

The IMKSE’s Vantage Galan 3T MR is key for articular pathology.

“The difference between the Canon Medical Vantage Galan 3T and other MRI machines on the market is that we can differentiate very small structures in the joints, which allows us to provide treatment during initial phases of injury. If lesions are bigger, they are more complicated to treat, and require a more difficult, more expensive and longer treatment for the patient to recover,” said Dr. Llopis. “We are happy with the system: the short tunnel and the 71 cm opening of the gantry significantly reduces the feeling of claustrophobia for the patient. The location of the hospital allows us to have natural light in the MRI room, which also helps reduce patient anxiety. All of this contributes to increased patient comfort.”

“ The Vantage Galan 3T MRI provides an image quality that is impressive.”

“The Vantage Galan 3T MRI provides an image quality that is impressive,” added Dr. Ignacio Muñoz Criado.
“When compared to others, you notice the difference. This is very important for us, because we often work with top athletes and, with this system, nothing goes unnoticed. This is key since when we see the cartilage lesions, we can carry out diagnostics and start a specific treatment for each player.”

The combination of Artificial intelligence (AI) and MRI enables the IMSKE to focus examination and treatment on a more personal level for each patient and to improve protocols. The scan times are shortened and the movement artefacts are minimized, so the need to repeat examinations can be avoided. All of the above ensures that the patient needs to spend less time in the machine.
Dr. Eva Llopis, Head of the Imaging Department at the IMSKE.
Although the Ziehm C-arm has not been used much until now we expect it to have a strong role as substitute for fluoroscopy for articular punctures.

The Aceso X-ray room is a manually operated system which is ideal for our MSK radiography. The system provides advanced automated tracking for the table and chest stand making it also the ideal system for Image Stitching examinations.Canon’s ultralight, high sensitivity detectors ensuring that the Aceso offers a superb all-around digital X-ray system for all our MSK imaging.

Dr. Llopis is very familiar with Canon Medical CT scanners. “As the Aquilion Lightning CT has the possibility to perform fluoroscopy, we also perform punctures although only a few have been carried out to now. We have already started to make pericyte infiltrations for extraforaminal sciatica in relation to deep gluteal syndromes,” she said.

 “With regards to CT: When you have a CT with high quality capabilities you can see that it has an incredible use,” added Dr. Ignacio Muñoz Criado.
“For example, today, a top basketball player came for a consultation.

X-ray showed that it could be a banal fracture; however, after performing a CT-scan we found out it was a spiral fracture of the finger. This is much more complex than what the general X-ray had shown. The CT images are very important for us because a 3D image helps the patients to understand their condition better. Patients leave with a lot more information and confidence about our diagnosis and treatment. This is why I have a display monitor to show the images to the patients and explain everything. The patient is the center of our universe. Moreover, high quality equipment for visualizing the images is also very important for our staff in their day-to-day work and helps them to provide high quality service to the patients.

“We can say that we have the best ultrasound system on the market, the Aplio i800.”

Pioneering developments

One area of interest of the IMSKE for MR developments is the Dixon technique. Dixon imaging allows us to obtain different types of image contrasts with a single acquisition. They are interested in looking at approaches that have less artefacts than Spin-Echo-based Dixon sequences.

“Since installation was only performed quite recently, we are still adapting to the new situation, but I’m sure that there are sequences that can be improved, and we have every confidence in Canon Medical when it comes to helping us to achieve this,” said Dr. Llopis. “We have a very good relationship with the application specialist and together we are working on the improvement of some specific techniques. We are very interested in improving the Dixon sequences.”

New protocols

With its advanced new equipment and the support of Canon Medical, the IMSKE is able to develop some new protocols in its specialist work.

“We need to examine lower limbs faster. Many examinations are performed here of sports teams and especially related to basketball. Basketball players are tall people and the most frequent muscular pathology is related to hamstrings, which are very difficult to examine using ultrasound when various muscle groups are affected. This is why you often need MRI. This is the modality that we are developing techniques in how to examine hamstrings as a whole. This type of examination in a normal person is done in a single sequence, but, for a basketball player, we need several. We are, therefore, developing a specific and faster protocol,” explained Dr. Llopis.

“We are also very interested in cartilage sequencing. We want to find out the essential condition in sports people, and not just because growth factor or stem cell techniques will be developed, but because we need imaging techniques to assess pre- and post-treatment and give validity to a surgical or medical technique. I’m very familiar with Vitrea, I believe it’s the best reconstruction console and I’ve got high expectations for dynamic examinations and cartilage segmentation sequencing,” she added.

Moving forward on a daily basis

With the motto: ‘Moving together’ (‘Nos movemos contigo’ in Spanish). The IMSKE recognizes that it can only progress if the patient progresses. “Only if our patient moves forward will we move forward. Only if our patient improves will we improve,” they say. With the support of Canon Medical, they are also moving together on a daily basis. //

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