Dr. Beatrix Nanai was born in Budapest, Hungary. She graduated from the University of Veterinary Sciences, Budapest Hungary in 1998 where she completed a surgical internship.

In 2001 she relocated to the United States and after receiving Educational Commission for Foreign Veterinary Graduates (ECFVG) certification, she completed a surgical externship at South Carolina Surgical Referral Services.
Between 2004-2007, she completed a residency in veterinary neurology and neurosurgery at Animal Emergency and Referral Center in Fort Pierce, Florida.

In 2007 she became a Diplomate of the European College of Veterinary Neurology/Neurosurgery.
She continued with her second residency training through the American College of Veterinary Surgeons at the Animal Emergency, Critical Care and Diagnostic Center in Melbourne, Florida. In 2014 she obtained her second spe-cialty board certification and became a Diplomate of the American College of Veterinary Surgeons. In 2016, Dr. Nanai moved to Pensacola and she is currently the head of the Surgery/Neurology department at the Veterinary Emergency Referral Center. Dr. Nanai enjoys sharing her knowledge and has given lectures for various veterinary medical associations, has several peer-reviewed publications and written articles for DVM360 Magazine. In her spare time, Dr. Nanai enjoys traveling with her husband, she loves entertaining her sphinx cat Nebka and she practices kung fu martial art.

Tell is a little about yourself, and you background in Veterinary Medicine.

My name is Doctor Nanai, and I was born and raised in Hungary, Budapest, and I went through veterinary school in Hungary, relocated to the United States, and I went through a neurology, neurosurgery residency through the European College of Veterinary Neurologists and became a specialist in 2007. And then I went back and completed a second residency through the American College of Veterinary Surgeons, and I became a diplomat in 2014.

What type of facility do you practice Veterinary Medicine at?

So, this is the Veterinary Emergency and Referral Center on Davis Highway, Pensacola, Florida. This is a 24-hour emergency and specialty practice. I am the surgeon and the neurologist, and we have a criticalist Dr. Bordelon, and we have seven emergency doctors.

What imaging equipment do you have within your facility?

We are very blessed to be well-equipped, and as you can see, we have the Vet-MR Grande and we do have a portable CT as well. We have fluoroscopy so we can perform interoperative fluoroscopy, ventricular stent placement. We do have digital radiography. We have several different ultrasounds and several different surgical equipment’s, like stapling devices.

How does MRI impact your Veterinary practice?

I suggest MRI, every neurology practice, in my opinion, we cannot these days, we cannot practice veterinary neurology without an access to an MRI.

Why did you choose the Vet-MR Grande from Esaote?

The Vet-MR Grande is a low-field MRI, which is was my choice, my first choice when I started, when I built up the neurology practice. The Vet-MR Grande was my first choice because I was just starting at this practice and I was not sure about my neurology caseload. It was very well-affordable for the practice and that the superior diagnostic quality.

When did you install the Vet-MR Grande?

We have installed a Vet-MR Grande one year after I came to this practice in 2018, and since then we are running it and it is a workhorse. We are doing three or four studies each day.

How does MRI complement CT in your Veterinary practice?

MRI is needed for all areas of neurology, and MRI investigates the central nervous system. We can image brains, spinal cords, peripheral nerves. As far as CT, CT looks mainly at bones, and CT is a complementary imaging modality to MRI. There are several conditions which requires both CT and MRI for a complete diagnosis and to understand those pathologies.

What has been the impact to your practice after installing the Vet MR-Grande?

The impact is huge. Because of Vet-MR Grande, I can practice neurology and we are able to take neurological cases from about 200 miles radius, because there is no other capability like this within 200 miles in this area. So, our neurology practice is very busy. We can take consultation cases and we can take emergency cases. There are a lot of neurological patients who need immediate diagnosis, for example, dogs who have developed seizures at their at early age and we suspect structural brain disease. We can provide a very fast and efficient diagnosis with a Vet-MR Grande, even within hours from their presentation to the hospital.

What were the factors your considered when choosing the MRI?

The decision how we decided with Vet-MR Grande was multifactorial. With every practice, the financials are playing roles and low-field MRIs are more affordable than high-field MRI’s. And yet we still have great diagnostic quality images. When I started, I was not sure about my caseload and what is going to be, and so we decided to get a low-field MRI as opposed to the high-field MRI. As far as within the low-field MRIs, why we decided with the What were the factors your considered when choosing the Vet-MR Grande, because I did work before Esaote-made MRI, the little brother of the Vet-MR Grande, and I was very satisfied with the reliability and with the images, what they could produce with such a low-field magnet. And I also like the company as far as the company support and training.

How long was the project to plan installation of the MRI?

That is a good question. It was now four years ago, so I do not exactly remember the details, but we probably it took us about six months to from start to finish from the top and from the negotiations or from talking to Esaote to actually to installation.

How did Esaote prepare you for operating the MRI?

Esaote was very nice because even before we received the MRI, they sent me to an MRI seminar specifically how to use the Vet MR-Grande. It was in Tucson and it was several days. And I learned a lot as far as about the machine, the magnet, and the usage. In addition to that, once they installed the machine, we got a week worth of training. Esaote sent us very educated people to teach us teach our doctors and technicians how to use the magnet.

How easy was it to learn to use the Vet-MR Grande?

The learning curve was very short, and that is one other advantage of Vet-MR Grande is that you do not have to go to MRI school to master at least the basic usage of the magnet. And it took us about a week of training and about 7 to 15 cases per person to get familiar with the sequences, with the usage.

How did you balance between the clinical aspect and economic aspect of choosing your MRI?

There is always a little trade-off what we do, especially with MRI, there is a trade-off of finances and image quality or diagnostic capability or the available sequences, and the balance at this point is that smaller private practice shows that we have made the right decision with Vet-MR Grande because of the financials and the maintenance. Maintaining the equipment is much less costly compared to the high-field MRIs. But at the same time, I have diagnostic quality images, I would say over 95 percent of the cases.

How does MRI complement the clinical expertise of the Veterinary Neurologist?

It reveals basically the pathology of what we can see. All I can do is localize the lesion. There is this in the brain is the neurological abnormality is evident the spinal cord or the peripheral nerves or what part of the spinal cord. But all lesions can create the same neurological presentation. So, if I put, let us say, a tumor within the cervical spine of the spine, or if I put a bullet or if I put a disc to the same location, you are going to see the same neurological signs, so we can localize it. The lesion is probably in the C spine, but we do not know what that is. And so, with the MRI, it's like an answering machine. Now we reveal what the pathology is so we can tell the owner the prognosis. Is this something which what we can fix or not? We can base our surgical planning based on that. We can tell them prognosis. Is your pet suffering or not?

It is an extremely important decision-making tool, even with a terminally ill patient. For example, the other day I had a dog, a seven-year-old dog who started having seizures six months earlier and the seizures did not respond to medication. So, we did the MRI after a cluster seizure once the pet was referred. And we did see, very sadly, that the patient had a large brain tumor with different type of brain herniations and possibly extremely high intracranial pressure. At that point, I did call the owner. Then the pet was still under general anesthesia for the scan, and this caused the very poor overall prognosis, and they decided that humane euthanasia. So that pet did not have to suffer after the MRI to wake up to deal with all those tremendous headaches which what this patient could have had. So even though the outcome is devastating and sad, we still provided a service and the way that they could cut suffering short just by using the MRI.

Is there a benefit to patient care to having in-house MRI?

There is a major advantage scanning patient in-house. I would trade off any day having the low magnet in-house versus needing to take the patient to a high-field facility. Absolutely. It is a game changer. And like I said, so the diagnostic quality of the images is there. Almost every single case. There might be a few cases where we can miss the diagnosis, that the pathology is such it affects such a small area, but those are the exceptions.

In your opinion, in-house MRI with the Vet-MR Grande outweighs delays in patient diagnosis when going to another high-field MRI facility?

Absolutely, 100 percent in a very fast, safe, and timely fashion.

What is the reaction of pet owners to having access to MRI in your Veterinary Clinic?

The [pet] owners are very appreciative and very surprised that this amazing imaging modality is available for animals in-house, especially in-house, a lot of people have not even heard about that. Oh, you know, you can image animals with CT and MRI and with these with this technology that it is available, especially in-house. I do explain the advantages of imaging in-house versus in an outside facility. As far as safety goes, everything is a much more controlled manner. Since these images require general anesthesia, we can provide a very safe environment for our pets. And people appreciate that.

What is your process of having images from the Vet-MR Grande reviewed and read?

That is a very good question and neurologists are different. I do believe that a second set of eyes should be laid on the images and neuro radiologists truly should look at the images as well. I always have my initial impressions right when the images are coming out, and I do tell the owner that I have an instant impression on the images and what the disease process might be. But I always tell them that all the images are transmitted to a neuro radiologist who I work with, who is luckily available on an emergency basis as well. And he reads the images, and he comes up with a final neuro radiology interpretation. And overall our opinion, in the vast majority of the cases, is the same. I would say about 96 percent of the time, we do agree. There could be some disagreement about 4 percent of the cases, but it's not going to change the outcome because we all both works together to set up the treatment plan and to get the best outcome for the patients.

How do you work with a Radiology reading service?

Having a teleradiology partner is extremely beneficial, in my opinion. I use a neurologist to read my images who has an extreme clinical experience who I can discuss all the case. And so he is not just looking at the images themselves, but he gives input as far as treatment. And I tell the owner that basically your pet will have two neurologists on the case. And because we are all here for the patient and we want to provide the best care and the best outcome.

What advantages are their to having an open design MRI system?

Yes, patient positioning is very easy, especially with the Vet-MR Grande, because they created this little window where we can look at the positioning and we do not have to come back and forth between the computer and the machine itself during positioning. All the coils are accommodating very well with all size of the patients and all type of patients, dogs, or cats. So, we are very, very satisfied with that. As far as scan time goes, we definitely there is a trade-off with low-field versus high-field, and you need to have a game plan. You need to know what you are looking for. You need to localize the lesion to decrease the scan time. Also, with the Vet-MR Grande or any low-field MRI, you need to choose wisely of each sequence you want to run and with which anatomical segment. And so that is one of the trade-off as far as low-field MRI. The scan times are longer than on the high-field, and we run about a regular brain scan, the total scan time about 40, 45 minutes with contrast administration.

What piece of advice would you give to a Veterinary practice considering an in-house MRI?

So, the diagnostic quality of the MRI, Vet-MR Grande is very high, and we can compare low-field with high-field. If they choose to get an in-house MRI and they if they are unsure of whether they can afford it long-term or generate enough cases to afford an MRI, I will definitely recommend Vet-MR Grande at least as a start in their practice.