Dissemination and Implementation
To implement and disseminate these proposed recommendations within the VHA, a workgroup of neurologists and radiologists was formed in late 2020. A review and discussion of the importance of each of the proposed MRI protocols for veterans with MS was held along with possible modifications to balance the intent of meeting standards of care with resources of individual US Department of Veterans Affairs (VA) medical centers and veterans’ needs. The final protocol recommendations were agreed on by group consensus.
In general, this VHA workgroup felt that the current adopted MRI protocols in several VA medical centers (based on previously proposed recommendations) were similar to the ones newly proposed and that implementing changes to meet the 2021 criteria would not be a major challenge.14,15 Possible regional and nonregional barriers were discussed. The result of these discussions led to a modified version of what could be considered more stringent guidelines to accommodate medical centers that had fewer imaging resources. This modified protocol offers a viable alternative that allows for minimizing heterogeneities while recognizing the capabilities of the available scanner fleet and meeting the needs of specific centers or veterans. Finally, the workgroup recognized a fundamental obstacle toward this harmonization process in the heterogeneity in vendors and scanner field strength, factors that have previously limited implementation.
The guidelines and proposed changes were then presented to the VA National Radiology Program Office, examined, and discussed for consensus. No changes were felt to be needed, and the recommendation to implement these guidelines in MS regional programs, whenever possible, was deemed appropriate.
At this time, a focused communication plan has been implemented to diffuse the use of this protocol at MS regional programs in the MSCoE network. We will work iteratively with individual sites to practically apply the guidelines, learn about challenges, and work through them to optimize local implementation.
Conclusions
Standardized MRI protocols are fundamental for the care of veterans with MS. Mitigating interscan variabilities should be recognized as a priority by scientific and clinical expert committees. Several guidelines have been developed over the years to standardize MRI acquisition protocols and interpretations, while updating the same to the latest discoveries.4,5,8,14,15 The VHA has been historically committed to these international efforts, with the goal to excel in the care of veterans with MS by providing access to state-of-the-art technologies. To this end, the initial Consortium of MS Centers MRI protocol was implemented in several MSCoE VA Regional Program sites a decade ago.14 Efforts continue to update protocol recommendations as needed and to promote their dissemination across the VHA enterprise.
This commentary is part of the continuous effort of the MSCoE to align with contemporary guidelines, apply the highest scientific standards, and achieve consistent outcomes for veterans with MS. For more important details of the clinical scenarios when additional/optional sequences or scans can be acquired, we advise the reader to refer to the 2021 MAGNIMS-CMSC-NAIMS Consensus Recommendations on the Use of MRI in Patients With Multiple Sclerosis.8