Abstract
My technical capstone project and STS research paper focus were motivated by the costs associated with Magnetic Resonance Imaging (MRI). MRI costs are notoriously high, and I’m especially passionate about the challenges that these types of expenses create within healthcare systems. MRI phantoms are one of the tools that contribute to high costs. Phantoms are objects used to test and calibrate an MRI machine as they mimic certain properties of human tissue. They are necessary for quality assurance, but are especially expensive. The Multiscale Muscle Mechanophysiology (M3) lab at UVA was seeking a more affordable option for testing their imaging equipment, so our Capstone focused on creating a low-cost MRI phantom specifically for their needs. While researching the costs of phantoms, I noticed significant discrepancies in MRI scan prices, which led me to want to explore the broader costs associated with MRIs–specifically investigating the ethical implications surrounding their pricing and distribution.
MRI phantoms use different materials as stand-ins for human tissue in an MRI scan. The materials are placed at known locations in the phantom so that a scan can be performed and compared to known measurements. They are used for quality control to confirm properties of an MRI unit so that high-resolution images can be produced and proper diagnosis can be made by medical professionals. Phantoms are necessary, but they aren’t accessible. A full body skeletal MRI phantom can cost up to 37 thousand dollars, which is expensive for researchers working under grants and limited funding. Although other lower-cost phantoms do exist, they still average around 2,000 dollars. We created a low-cost phantom for the M3 lab at UVA that accurately mimics bone, muscle, and fat. We also presented varying muscle orientations, some with representative muscle fibers and some more anatomically accurate in shape. We hope that our phantom design will encourage others to develop their own test subjects for lower-cost research.
My STS paper focuses on the ethical standings of the costs and utilization of MRI machines. I performed a historical analysis on the prices of MRI scans using data from public health organizations, organizations offering MRIs, insurance companies, and social media posts. The purpose of the AMA’s code of ethics is to publicly declare the values that members of medical practices are committed to and how they will conduct themselves. As MRIs are a medical tool, their use is subject to the AMA code of ethics and held accountable by medical boards and other practices. Throughout my research, I found that despite their importance as a diagnostic tool, many cannot take advantage of MRI technology due to inadequate insurance coverage and high upfront costs, while MRI owners are profiting millions of dollars and misusing the technology. This situation raises ethical concerns, as it places other factors above patient well-being, which directly contradicts the core principles of medical ethics. The AMA code of ethics states institutions should promote equitable care for all and make efforts to change policies that perpetuate barriers to equitable care. However, the high prices associated with MRI scans create barriers to care. The code also brings up that the obligation of a physician to the patient must override considerations of financial incentives, but excessive profits earned by MRI owners disobey this principle of obligation to the patient. The code even mentioned health insurers and their role in working to ensure sufficient access to appropriate healthcare for all people, however they often fail to uphold this principle. I hope that my thesis influences others to begin scrutinizing medical costs and that physicians, medical boards, insurance companies, and other healthcare workers may work together to hold each other accountable to the AMA code of ethics in an attempt to decrease costs for the benefit of patients.
Working on both my technical report and STS research paper at the same time opened up different perspectives to look into, specifically in my thesis research. Being hands-on with an actual MRI machine and seeing the process of a scan gave me a better understanding of the MRI network and things that might affect price. Getting the results from an MRI scan and talking to radiologists proved just how useful they could be for patients. Writing my research paper also inspired the creation of our phantom, as I learned just how important lowering costs for MRI users is in order to lower costs for patients. There are still so many questions to be asked about pricing in healthcare, and I hope that my STS research paper and technical project motivate others to explore possible improvement opportunities in regards to healthcare costs.
