Neuroimaging bottlenecks are a well-established cause of delays in dementia assessment across the UK.^{Reference Nicholls, Quirk, Corrado, Swanson, Hood and Essel1} Ultra-low field magnetic resonance imaging (ULF-MRI) has the potential to radically change how neuroimaging is used in the assessment of dementia. ULF-MRI scanners use a fraction of the magnetic field strength of standard MRI scanners and do not require expensive cooling or shielding. They also cost a fraction of standard scanners to buy and maintain, are small and robust enough to be used in community clinics, and do not require specialist operators.^{Reference Kimberly, Sorby-Adams, Webb, Wu, Beekman and Bowry2} A growing body of evidence has described strong correlations between ULF and standard MRI on key measures relevant to dementia diagnosis, including regional atrophy and white matter changes.^{Reference Sorby-Adams, Guo, Laso, Kirsch, Zabinska and Garcia Guarniz3} The potential for synergy with other technological advancements was demonstrated by Deoni et al. (2023), who fitted an ULF-MRI scanner in a Ford Transit van for a community study that combined mobile neuroimaging with web-based remote cognitive assessment.^{Reference Deoni, Medeiros, Deoni, Burton, Beauchemin and D’Sa4}

Despite the importance of timely dementia diagnosis, many people currently experience long waits for assessment and diagnosis. Neuroimaging usually takes place in general hospitals away from community-based memory clinics, and access for people in rural or coastal areas is often compromised through limited transport connections.⁵ Through increasing capacity and providing point-of-care neuroimaging in the community, ULF-MRI has the potential to reduce inequalities and time to diagnosis, and improve patient experience.

With the aim of contributing to an emerging evidence base with data on the perspectives of people with lived experience of dementia regarding the use of ULF-MRI scanning within dementia assessment and research, we conducted a series of community focus groups and interviews with people living with dementia and carers. We recruited participants through robust engagement with local voluntary organisations. From this, a snowballing method was employed,^{Reference Bowling6} whereby organisations helped to further identify participants who were members of such groups. Our sample included participants from coastal, rural and urban communities in Kent. A broad topic guide was used and written informed consent was obtained before commencing interviews and focus groups, which were recorded and transcribed and data were analysed through thematic analysis.

Focus groups and interviews took place between February and June 2024. 35 participants (24 female, 11 male, mean age 72 (range 22–88) took part in focus groups (n = 20) or interviews (n = 15). 12 participants were people with dementia and 23 were carers.

We identified five main themes: access to local neuroimaging, improvement of assessment pathways, accuracy of ULF-MRI, concerns about cost and diagnostic quality, and engagement in future ULF-MRI research.

The overall response to the idea of using ULF-MRI in dementia assessment and research was positive, in particular the idea of community-based imaging.

Participants felt ULF-MRI had the potential to improve diagnostic pathways and reduce waiting times:

Participants were excited about the potential of ULF-MRI, and there was widespread willingness to engage in future research:

Participants were concerned that ULF-MRI could be used as a way to cut costs at the expense of quality:

Concerns around the accuracy of ULF-MRI scanning and its diagnostic value in rare types of dementia were also expressed:

Participants were concerned that if ULF-MRI did not provide sufficiently detailed information, some people may still need further neuroimaging. This was generally considered to be acceptable as long as patients could access the investigations required.

Many participants were from coastal and rural communities. Therefore, it is not a surprise that they supported the idea of locally-available neuroimaging. In areas with reduced public transport links, access to healthcare is also reduced, thus restricting access to diagnosis.⁵ Dementia diagnosis rates in rural and coastal areas are far lower than the national target of 66.7%.⁷ ULF-MRI offers the opportunity to deliver point of care neuroimaging,^{Reference Wald, McDaniel, Witzel, Stockmann and Cooley8} and thus to reduce inequalities in access to imaging and timely diagnosis and care in underserved communities.

ULF-MRI scanners cost a fraction of traditional MRI scanners to buy and maintain.^{Reference Altaf, Shakir, Irshad, Atif, Kumari and Islam9} Based on the views expressed by participants, it will be important to share clear information regarding the uses and limitations of ULF-MRI, such that community members are confident that it is used appropriately to aid diagnosis, and not to reduce costs at the expense of diagnostic accuracy. Ongoing research will establish more about the clinical utility of ULF-MRI in dementia assessment, and patients and the public need easily accessible information regarding the outcomes of these studies.

In conclusion, people with lived experience of dementia were optimistic about the potential of ULF-MRI, in particular the possibility of speedy access to neuroimaging in the local community. There was recognition that the technology would not replace existing neuroimaging methods, but very positive discussions about the possibility that ULF-MRI could improve dementia diagnosis pathways and waiting times, and reduce inequalities. It will be important to recognise and address the concerns highlighted regarding appropriate use of this new technology, and its diagnostic value. There is a growing body of evidence that ULF-MRI can meaningfully transform dementia diagnosis pathways; for this to have maximum impact, we must ensure that patients and the public are an integral part of the development of this work.