Case-based review of low-field MRI in resource-constrained settings: a clinical perspective from Malawi

Low-field MRI (LF-MRI) is in the spotlight as multidisciplinary experts consider it to be one solution to expanding MRI access worldwide. The clinical scenarios and case-mix in which LF-MRI could play an especially important role in the patient diagnostic algorithm are different in High and Low- and Middle-Income Countries (LMIC). The aim of this article is to suggest a robust structure within which to envision clinical use and advancement of LF-MRI technology in LMICs. This article presents three discrete clinical scenarios-a tertiary care facility with an LF-MRI only, a tertiary care facility with an LF-MRI and an HF-MRI and a peripheral healthcare facility with an LF-MRI only-derived from a combination of the authors' observed practice and hypothetical models in an LMIC and 31 consecutive case reviews within a 32-month timeframe of our experience with the 0.064 T Hyperfine Swoop in Malawi. The authors recognize the important of a holistic approach to the ongoing multifaceted efforts at LMIC-appropriate advancement of LF-MRI technology. This ranges from continued innovation relating to deep learning methods for improved diagnostic accuracy and workflow efficiency, empowerment towards building LF-MRIs in-situ in the LMIC and multidisciplinary capacity building initiatives in LMICs.