Functional MRI (fMRI) is no longer limited to research laboratories – it is increasingly becoming an integral part of routine clinical care. At NordicNeuroLab’s fMRI User Meeting earlier this year, consultant neuroradiologist Dr. Khaled Gad shared his experience in building a clinical fMRI service in Kuwait, from the ground up.
Drawing on his dual background in academic research and clinical practice, Khaled highlighted not only the technical requirements, but also the structural, ethical, and procedural challenges involved in creating a sustainable service.
Reflecting on the early stages, Khaled recalls:
– When I started, I asked myself: Why don’t we already have a clinical fMRI service? It turned out there were many unanswered questions – and very little standardization.
From idea to infrastructure
In his presentation, Khaled explained that the first step was to understand where fMRI could make the biggest difference. He identified clinical areas such as neurosurgery, neurology, and psychiatry, where the method could directly support patient care. At the same time, he reviewed the hospital’s existing hardware and software to see what needed upgrading.
When launching the service, he chose to start small, focusing on high-value cases involving language and motor mapping. This resulted in a small quantity of clear, clinically useful results without overwhelming the workflow – and created a solid platform for further growth.
Building collaboration across disciplines
Khaled explained that developing a clinical fMRI service was not just a technical ask – it meant bridging the gap between research and clinical practice. To make this possible, he brought together a broad team including radiologists, neurosurgeons, neurologists, radiographers, physicists and psychologists.
– It was essential to bridge the gap between research and clinical expectations, especially when it came to reporting and workflows, he said.
At first, there was scepticism – especially from neurosurgeons that were used to relying solely on traditional intraoperative mapping. But with persistence, evidence-based presentations, and real patient demonstrations, Khaled gradually earned their trust and built the foundation for long-term collaboration.
Standardizing paradigms and reporting
Once the service was running, the next challenge was consistency. Khaled and his team developed standardized paradigms and reporting templates to ensure clarity and reproducibility.
– We didn’t have a defined clinical fMRI protocol. We had to build everything, from paradigms to report templates, from scratch, he explained.
Reports were written in concise, clinically relevant language, translating complex imaging results into insights that surgeons and neurologists could use. Interactive sessions with clinical teams reviewed post-processing steps, validated activations, and helped build confidence in the reliability of the results.
Training, workflow and patient preparation
Another pillar of success was the training. Radiographers, radiologists, and referring physicians took part in workshops and hands-on sessions, and followed detailed guidance documentation to build competence and confidence.
Khaled also discussed the importance of patient preparation. Assessing cognitive and motor abilities, ensuring task compliance during scans, and minimizing the risk of false negatives were all crucial. These measures optimized both the technical and human factors needed for accurate, actionable outcomes.
From pilot cases to long-term integration
In his presentation, Khaled also illustrated the impact of clinical fMRI with early pilot cases. In one motor mapping scenario, fMRI revealed a displaced hand area near a tumour, allowing the surgeon to adjust the approach and preserve function. In another, language mapping made it possible to cancel an awake craniotomy, enabling a procedure that was safer and more comfortable for the patient, without affecting language function.
These successes built trust among clinical teams and gradually the demand for fMRI increased. Over time, consistent referrals, positive patient outcomes and collaborative feedback supported expansion – including plans for additional scanners and deeper integration into hospital workflows.
Trust, collaboration, and clinical impact
Khaled’s experience reinforces that establishing a clinical fMRI service is about far more than technology – it’s about building trust, demonstrating value, and integrating research expertise into patient care. Success depends on collaboration, clear communication, and structured workflows.
– Success isn’t just scanning patients – it’s when your neurologists start asking for fMRI because it improves patient care, Khaled observes.
His talk made it clear that the journey from research to routine clinical fMRI is as much about people, processes, and collaboration as it is about technology. By building trust, standardizing protocols, and fostering teamwork across disciplines, fMRI can move from a specialized tool to a core part of patient care.
Looking ahead, Khaled aims to expand into pediatric protocols, resting-state fMRI, and AI-enhanced imaging. His vision points toward a future where clinical fMRI not only improves surgical safety and precision but also continues to advance personalized neurological care outside of presurgical mapping.
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