Research
February 4, 2026

Abbreviated Hepatocellular Carcinoma MRI Protocols Have Many Benefits

Z. Jane Wang, MD and Sean Woolen, MD, MS

Efficiency gains in MRI can benefit patients and clinicians, while saving costs and addressing environmental concerns. A primarily UCSF team led by first author Sean Woolen, MD, MS, and senior author Jane Wang, MD, conducted a retrospective single-center quality improvement study to evaluate time, energy use, and appointment access effects of new abbreviated MRI protocols for semiannual hepatocellular carcinoma surveillance. Their results were published in the Canadian Association of Radiologists Journal.

Hepatocellular carcinoma (HCC) remains a primary cause of cancer-related mortality, particularly for individuals living with cirrhosis or chronic hepatitis B. While many expert associations recommend semiannual surveillance using abdominal ultrasound, this method can be hindered by poor visualization. Factors such as obesity, nonalcoholic fatty liver disease, and advanced cirrhosis can make ultrasound less reliable. While standard MRI offers a more comprehensive view, its widespread adoption has been limited by long scan durations, high costs, and restricted accessibility.

Abbreviated MRI protocols address these barriers by eliminating specific sequences while maintaining high sensitivity for early-stage HCC detection. These condensed imaging techniques significantly reduce exam duration, which directly impacts the patient experience. Patients generally prefer abbreviated protocols over full scans due to the increased comfort and convenience, which is a critical factor in ensuring long-term surveillance compliance.

The study quantitatively assessed the environmental and operational impact of shorter protocols, finding that they reduced total scan time by 17.7 minutes, or 60%. This efficiency resulted in a per-exam savings of 7.0 kWh of energy and a reduction of 4.7 kg CO2eq in greenhouse gas emissions. Over the cumulative study period, the savings reached 2,226 kWh and 1,495 kg CO2eq, demonstrating that clinical efficiency can serve as a powerful tool for environmental sustainability.

However, the findings also emphasized a significant gap in current implementation. The researchers noted limitations in ordering and workflow processes such as referring providers using a single MRI abdomen order and protocol selection typically occurring after an appointment has already been scheduled. These limitations prevent the hospital system from capitalizing on the shorter scan times to increase patient throughput. To fully realize the benefits of these abbreviated protocols, healthcare systems must adopt scheduling adaptations that allow for protocol specific appointment slots that align with operational workflow. By optimizing scheduling, hospitals can improve scanner access and ensure more patients receive timely, life-saving surveillance.

Co-authors from the UCSF Department of Radiology and Biomedical Imaging: Fayyaz Ahmed, Marc D Kohli, Alastair Martin. Other investigators are at the Imaging Institute at Cleveland Clinic, and Quantivly Inc.