Updates to the MRI Protocol and Clinical Guidelines for MS: CMSC Working Group - Episode 8

Barriers in Use of CMSC Protocol

June Halper, MSN, APC-C, MSCN, FAAN: Speaking of barriers, we did have a discussion about the Canadian experience, and it was very eye-opening to me, despite the Canadian strength of the network, that very few people are using the CMSC [Consortium of Multiple Sclerosis Centers] guidelines, or the original CMSC protocol.

How are we going to overcome these barriers? Let’s talk a little bit about how we all want to do it. We’re 5 of us, and we had a few people at the meeting. But it just seems since 2001, we’re not getting the message out. What are your thoughts about how we can overcome the barriers and make it user friendly? There was some discussion yesterday about prostate protocol with the scanning. Why can’t we get this accepted as an international protocol? And if not, why, and how can we change this?

Anthony Traboulsee, MD, FRCPC: One of the telling messages yesterday was 1 of our colleagues who’s a radiologist was a little reluctant to change his way of doing image acquisition to the recommended protocol. But when he did it, he said he loved it. He found it didn’t take more work for him. It actually took less time to acquire the data, and he’s starting to use that same protocol for other studies. Part of it is just trying to get that message across that this is not more work for the MRI [magnetic resonance imaging] centers. It’s not going to take up more time or more cost, and it might improve their work flow overall. That’s working at the micro level, and then on the macro level, that’s why David was able to bring a lot of vendors to the table. They were very positive about how they could potentially contribute to getting this more endorsed at the manufacturer level and perhaps getting more standardized cards onto the scanners as new scanners are being updated.

June Halper, MSN, APC-C, MSCN, FAAN: Well, it seems to me what you did yesterday, getting those people from the manufacturers, was a huge first step. There’s always this dichotomy between the clinician and industry, but in this case, they had a really strong voice. I really enjoyed listening to their opinion and understanding their problems. This is because they have as many problems from their end.

Frederik Barkhof, MD, PhD: That’s why it’s good that we have an international alignment because they made it very clear. If the Europeans have a different demand than the North Americans, we are a global company. We cannot provide different protocols in different parts of the world. I think it’s important that we align on what are the core sequences, and if we all agree on it, they will have to follow suit, I think, and make that available to us in a practical manner and in a way that is comparable across the vendors who obviously have a different agenda. They want to differentiate themselves. They don’t want to be similar because then they’re helping their competition. But we need to force them to converge and agree on a core protocol, and it only works if we are internationally aligned. Otherwise, they don’t know who to follow.

June Halper, MSN, APC-C, MSCN, FAAN: Absolutely.

Scott D. Newsome, DO, MSCS, FAAN: I think taking a multipronged approach is the most important. Given that it’s been over a decade since the original guidelines meeting, at least the CMSC meeting, the word hasn’t spread to taking the international approach, partnering up with people globally. Then, I think including the vendors was really impressive.

June Halper, MSN, APC-C, MSCN, FAAN: That was a great idea, David, really.

Scott D. Newsome, DO, MSCS, FAAN: Also including the last reiteration, organizations like the American radiology groups come to the table as well because they have a big voice in it. We have to look at where there may be opportunities that weren’t tapped into in years past. We talked about how people will recognize or won’t forget studies or guidelines if you continue to, it sounds terrible, but put it in their face. This is if you constantly put it out there and say, “OK, this is why it’s important to have these guidelines for clinical care.” So as much as we can push it forward, whether it’s abstracts at meetings or paper handouts, I think that’s going to disseminate it quite well.

June Halper, MSN, APC-C, MSCN, FAAN: But you need a level playing field. I saw that yesterday quite clearly. We have gotten very skittish about interacting with pharma and interacting with industry. But, having the voice of the manufacturer at the table was quite an eye-opener. I realize that they have some profit motive, but they also have a workload that they have to deal with. Two voices, 1 coming from Europe and 1 from the United States and Canada makes it difficult. So I think what you said, Fred, is right. Maybe by bringing them to the table, we’re giving them a level playing field to play from, makes the most sense. Don’t you think so, Tony?

Anthony Traboulsee, MD, FRCPC: Absolutely, and also there are a lot of good regional approaches toward this. You and Ellen Mowry, MD, have been very successful in getting a lot of centers on the East Coast to adopt a standardized protocol that’s compatible with what we’ve been recommending.

Scott D. Newsome, DO, MSCS, FAAN: It takes a lot of work, right? Like you said, it’s a lot of work that goes into it, and it’s a lot of education to show how this is not going to be over burdensome, how it’s not actually changing the work flow for the radiology center or centers. It actually is improving the throughput, like your radiologist in Vancouver, Canada. Once you can get someone to try it and they see how easy it is, then they start using it for other indications. It’s an educational journey, and we have to again be at the doorstep of many of these places.